321 Mental Health/Substance Abuse Crisis Response Center, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

C009113 Issued in NC

Legal business name

321 MENTAL HEALTH/SUBSTANCE ABUSE CRISIS RESPONSE CENTER, PLLC

Practice address

3232 Summerfield Ridge LN
Matthews, NC 28105-8507

Phone

(704) 918-8513

Fax

(704) 291-9354

NPI assigned

Jun 27, 2015

Last updated

Aug 19, 2015By 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. Regenia Mae Hubbard, LCSW

Title

Owner/Operator

Phone

(919) 247-0535

Specialties & licenses 1

Addresses

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.

• Dejerica Tinsley, LCSW

  • Clinical Social Worker
  • Marietta, GA
  • NPI 1942667688

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1435363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1861874794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 562",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281060562",
            "telephone_number": "704-918-8513",
            "fax_number": "704-291-9354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 SUMMERFIELD RIDGE LN",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281058507",
            "telephone_number": "704-918-8513",
            "fax_number": "704-291-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "321 MENTAL HEALTH/SUBSTANCE ABUSE CRISIS RESPONSE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-27",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "REGENIA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "919-247-0535",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "C009113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Matthews, NC
• Providers in Matthews, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; 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.