1528563194 NPI number — THREE OAKS BEHAVIORAL HEALTH & WELLNESS

Table of content: (NPI 1528563194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528563194 NPI number — THREE OAKS BEHAVIORAL HEALTH & WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE OAKS BEHAVIORAL HEALTH & WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528563194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1013 BULLARD CT STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-6801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-430-4466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 BULLARD CT STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-430-4466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
CASIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-430-4466

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCAS-21329 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 11825 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11825 . This is a "NORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: LCAS-21329 . This is a "NORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com