Provider Demographics
NPI:1740415389
Name:SOUTHEASTERN BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:SOUTHEASTERN BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-1587
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1004
Mailing Address - Country:US
Mailing Address - Phone:910-738-1587
Mailing Address - Fax:910-738-1581
Practice Address - Street 1:805 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2735
Practice Address - Country:US
Practice Address - Phone:910-738-1587
Practice Address - Fax:910-738-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL078167251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302190Medicaid
NC8302190GMedicaid
NC8302190KMedicaid