Basic Information
| Provider Information | |||||||||
| NPI: | 1538213343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBEMARLE MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27909 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 305 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523350803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRANKLIN | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | AREA DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2523351113 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 5901709 | 05 | NC | MEDICAID |