Provider Demographics
NPI:1972659753
Name:ALBEMARLE MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:ALBEMARLE MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-335-1113
Mailing Address - Street 1:SUN REALTY BUILDING
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NC
Mailing Address - Zip Code:27915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SUN REALTY BUILDING
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NC
Practice Address - Zip Code:27915
Practice Address - Country:US
Practice Address - Phone:252-995-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901703Medicaid