Provider Demographics
NPI:1851410450
Name:JOHNSTON COUNTY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:JOHNSTON COUNTY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:919-989-5500
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0411
Mailing Address - Country:US
Mailing Address - Phone:919-989-5500
Mailing Address - Fax:919-989-5532
Practice Address - Street 1:521 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-989-5500
Practice Address - Fax:919-989-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005572Medicaid
NC8301360Medicaid
NC5901802Medicaid
NC07116OtherBCBS-NC
NC3404930Medicaid
NC8301360BMedicaid
NC8301360Medicaid