# SEQUEL TSI OF NORTH CAROLINA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679802458
- **Authorized official:** JOHN STUPAK (PRESIDENT)
- **Authorized official phone:** (267) 419-8913

## Contact information

- **Practice address:** 2480 HADLEY MILL RD, PITTSBORO, NC 27312-7832
- **Practice address phone:** (919) 542-1104
- **Practice address fax:** (919) 542-5565
- **Mailing address:** PO BOX 1370, PITTSBORO, NC 27312-1370
- **Mailing address phone:** (919) 542-1104
- **Mailing address fax:** (919) 542-5565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2009
- **Last updated:** 12/08/2009