Provider Demographics
NPI:1790928752
Name:ST. MARGARET BEHAVIOR HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ST. MARGARET BEHAVIOR HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:YEBOA
Authorized Official - Last Name:SIAKWAN
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICAL THERAPIST
Authorized Official - Phone:252-268-5433
Mailing Address - Street 1:3180 BALLARDS CROSSROADS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4707
Mailing Address - Country:US
Mailing Address - Phone:252-227-4009
Mailing Address - Fax:252-227-4009
Practice Address - Street 1:3180 BALLARDS CROSSROADS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4707
Practice Address - Country:US
Practice Address - Phone:252-227-4009
Practice Address - Fax:252-227-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1065101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111899Medicaid