Basic Information
| Provider Information | |||||||||
| NPI: | 1013012400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBEMARLE MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279094425 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279094425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523350803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRANKLIN | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | LME/AREA PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2523350431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 07051 | 01 | NC | BC/BS | OTHER | 3404943 | 05 | NC | MEDICAID |