Provider Demographics
NPI:1770564031
Name:TAR HEEL HUMAN SERVICES-MENTAL HEALTH DIVISION, INC.
Entity type:Organization
Organization Name:TAR HEEL HUMAN SERVICES-MENTAL HEALTH DIVISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:910-298-6207
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-1321
Mailing Address - Country:US
Mailing Address - Phone:910-298-9207
Mailing Address - Fax:910-298-6293
Practice Address - Street 1:193 N. NC HWY 41
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:910-298-6207
Practice Address - Fax:910-298-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016UOOtherBCBS
NC6005238Medicaid
NCB0547OtherMEDCOST
NC2346016Medicare ID - Type Unspecified