The Mentor Network

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE MENTOR NETWORK

Practice address

241 Grant Street
West End, NC 27376

Phone

(910) 673-3535

Fax

(901) 673-6565

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Devault Clevenger, MA LCSW

Title

Program Manager

Phone

(910) 673-3535

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376620138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "BISCOE",
            "state": "NC",
            "postal_code": "272090310",
            "telephone_number": "910-673-3535",
            "fax_number": "910-673-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 GRANT STREET",
            "city": "WEST END",
            "state": "NC",
            "postal_code": "27376",
            "telephone_number": "910-673-3535",
            "fax_number": "901-673-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MENTOR NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLEVENGER",
        "authorized_official_first_name": "DEVAULT",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "910-673-3535",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005890",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in West End, NC
• Providers in West End, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.