Provider Demographics
NPI:1992973895
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:R
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-335-1113
Mailing Address - Street 1:804 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-2224
Mailing Address - Country:US
Mailing Address - Phone:252-793-1154
Mailing Address - Fax:252-793-3860
Practice Address - Street 1:804 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-2224
Practice Address - Country:US
Practice Address - Phone:252-793-1154
Practice Address - Fax:252-793-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901900Medicaid