Provider Demographics
NPI:1336912245
Name:NC MENTAL HEALTH PROVIDER PROFESSIONALS NC MH PP
Entity Type:Organization
Organization Name:NC MENTAL HEALTH PROVIDER PROFESSIONALS NC MH PP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:LETRICE
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-300-0971
Mailing Address - Street 1:1235 EAST BLVD # 1272
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5870
Mailing Address - Country:US
Mailing Address - Phone:980-343-9117
Mailing Address - Fax:
Practice Address - Street 1:1235 EAST BLVD # 1272
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5870
Practice Address - Country:US
Practice Address - Phone:980-343-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health