Provider Demographics
NPI:1811050982
Name:CONCERN OF DURHAM, INC
Entity type:Organization
Organization Name:CONCERN OF DURHAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:YASHAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MS
Authorized Official - Phone:919-489-5652
Mailing Address - Street 1:3001 ACADEMY RD
Mailing Address - Street 2:230
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2660
Mailing Address - Country:US
Mailing Address - Phone:919-489-5652
Mailing Address - Fax:919-490-6288
Practice Address - Street 1:3001 ACADEMY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2660
Practice Address - Country:US
Practice Address - Phone:919-489-5652
Practice Address - Fax:919-490-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032-054 & 032-016322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC320942OtherVALUE OPTIONS PROVIDER NU
NCMHL-032-016OtherMH PROVIDER #
NCH22001OtherDSS PROVIDER NUMBER
NCH22002OtherDSS PROVIDER NUMBER
NC6603008Medicaid
NC0176MOtherBC/BS
NCMHL-032-054OtherMENTAL HEALTH PROVIDER #
NC6603009Medicaid