Provider Demographics
NPI:1447355888
Name:JOHNSTON COUNTY MENTAL HEALTH CTR
Entity type:Organization
Organization Name:JOHNSTON COUNTY MENTAL HEALTH CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-989-5500
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:JOHNSTON COUNTY MENTAL HEALTH CENTER
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0411
Mailing Address - Country:US
Mailing Address - Phone:919-989-5500
Mailing Address - Fax:919-989-5532
Practice Address - Street 1:521 N BRIGHTLEAF BLVD
Practice Address - Street 2:JOHNSTON COUNTY MEDICAL HEALTH CENTER
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-989-5500
Practice Address - Fax:919-989-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404930Medicaid
NC6005572Medicaid
NC8301360Medicaid
NC8301360BMedicaid
NC07116OtherBCBC
NC5901802Medicaid
NC5901802Medicaid