Provider Demographics
NPI:1194888016
Name:CAROLINA PROFESSIONAL MENTAL HEALTH ASSOCIATES, INC.
Entity type:Organization
Organization Name:CAROLINA PROFESSIONAL MENTAL HEALTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PLCSW
Authorized Official - Phone:910-272-9356
Mailing Address - Street 1:109 N COURT SQ
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5554
Mailing Address - Country:US
Mailing Address - Phone:910-272-9356
Mailing Address - Fax:
Practice Address - Street 1:109 N COURT SQ
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5554
Practice Address - Country:US
Practice Address - Phone:910-272-9356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905355Medicaid
NC6106443Medicaid
NC8300659Medicaid
NC8300659GMedicaid
NC6103405Medicaid
NC3408172Medicaid
NC8300659BMedicaid
NC8300659HMedicaid
NC6005977Medicaid
NC8300659RMedicaid
NC5901420Medicaid