Provider Demographics
NPI:1861874794
Name:321 MENTAL HEALTH/SUBSTANCE ABUSE CRISIS RESPONSE CENTER, PLLC
Entity type:Organization
Organization Name:321 MENTAL HEALTH/SUBSTANCE ABUSE CRISIS RESPONSE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGENIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-247-0535
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-0562
Mailing Address - Country:US
Mailing Address - Phone:704-918-8513
Mailing Address - Fax:704-291-9354
Practice Address - Street 1:3232 SUMMERFIELD RIDGE LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8507
Practice Address - Country:US
Practice Address - Phone:704-918-8513
Practice Address - Fax:704-291-9354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-27
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC009113251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health