Provider Demographics
NPI:1538344049
Name:NAVARRE BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:NAVARRE BEHAVIORAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-884-9033
Mailing Address - Street 1:PO BOX 1015
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-1015
Mailing Address - Country:US
Mailing Address - Phone:919-884-9033
Mailing Address - Fax:888-242-6653
Practice Address - Street 1:1140 SAVANNAH RIDGE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:919-884-9033
Practice Address - Fax:919-884-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8804251S00000X
NCC004448251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTAN AH934Medicare PIN