Collegial Behavioral Health, PLLC

Key facts

NPI

1780191627

Entity type

Organization (NPI type 2)

Primary specialty

Physician Assistant 363A00000X

License

0010-05553 (NC)

Legal business name

COLLEGIAL BEHAVIORAL HEALTH, PLLC

Practice address

12740 Spruce Tree Way Ste 102
Raleigh, NC 27614-8295

Phone

(919) 916-1160

Fax

(919) 488-4226

NPI assigned

Jan 1, 2018

Organization subpart

No

Authorized official

Name

Mr. Owen Wang

Title

Office Manager

Phone

(626) 808-6428

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandra Alexander Physician Assistant · Myrtle Beach, SC · NPI 1457741746
  NPD (past) PHYSICIAN ASSISTANT

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2019.

{
    "created_epoch": "1514764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1780191627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12740 SPRUCE TREE WAY STE 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148295",
            "telephone_number": "919-916-1160",
            "fax_number": "919-488-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12740 SPRUCE TREE WAY STE 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148295",
            "telephone_number": "919-916-1160",
            "fax_number": "919-488-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGIAL BEHAVIORAL HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-01",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "OWEN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "626-808-6428",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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