Provider Demographics
NPI:1942637392
Name:PHYSICIAN ALLIANCE OF MENTAL HEALTH
Entity Type:Organization
Organization Name:PHYSICIAN ALLIANCE OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTENSIVE IN HOME TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LINETTE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:910-794-3929
Mailing Address - Street 1:PO BOX 15511
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5511
Mailing Address - Country:US
Mailing Address - Phone:910-794-3929
Mailing Address - Fax:
Practice Address - Street 1:3208 OLEANDER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28408-5511
Practice Address - Country:US
Practice Address - Phone:910-794-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008312251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health