Statewide Mental Health & Disability Services, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34782 Issued in NC

Legal business name

STATEWIDE MENTAL HEALTH & DISABILITY SERVICES, PLLC

Practice address

64 Knight Rd
Hollister, NC 27844-9791

Phone

(252) 308-1247

Fax

(252) 308-1248

NPI assigned

Mar 31, 2014

Last updated

Jul 31, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kristin Clayton, MSW, LCSWNPI 1801917679

Title

Ceo

Phone

(252) 308-1247

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristin Clayton

  • Clinical Social Worker
  • Roanoke Rapids, NC
  • NPI 1801917679
  NPD (past) Authorized official

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

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1427476167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 ROANOKE AVENUE",
            "address_2": "SUITE A-1",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278702740",
            "telephone_number": "252-308-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 KNIGHT RD",
            "city": "HOLLISTER",
            "state": "NC",
            "postal_code": "278449791",
            "telephone_number": "252-308-1247",
            "fax_number": "252-308-1248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE MENTAL HEALTH & DISABILITY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-308-1247",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "34782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003794",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jade Alexia Mills, PHARMD
• Ladonna Denise Richardson, LCSW
• Rural Health Group Inc (Rural Health Group at Twin County)
• Rural Health Group, Inc (RHG Pharmacy)
• Dawn Nichole Rush, PHARMD
• Twin County Rural Health Center, Inc.

• Family Medicine Physician in Hollister, NC
• Providers in Hollister, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; 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.