Provider Demographics
NPI:1487909636
Name:VISIONS OF NORTH CAROLINA, INC.
Entity type:Organization
Organization Name:VISIONS OF NORTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC./QM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOZELL
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP, EDD
Authorized Official - Phone:336-549-1796
Mailing Address - Street 1:7607A ALCORN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9781
Mailing Address - Country:US
Mailing Address - Phone:336-931-0432
Mailing Address - Fax:336-370-9009
Practice Address - Street 1:122 N ELM ST STE 505
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2875
Practice Address - Country:US
Practice Address - Phone:336-275-1125
Practice Address - Fax:336-275-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1048251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410155Medicaid