Provider Demographics
NPI:1942553128
Name:JERLON BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:JERLON BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-314-1458
Mailing Address - Street 1:404 NEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27886-5429
Mailing Address - Country:US
Mailing Address - Phone:252-314-1458
Mailing Address - Fax:
Practice Address - Street 1:404 NEVILLE ST
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27886-5429
Practice Address - Country:US
Practice Address - Phone:252-314-1458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health