Organization
MACTA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL W WOOTEN (OWNER/MEMBER)
(252) 443-0836
Entity
Organization
Contact information
Practice address
450 S WESLEYAN BLVD, ROCKY MOUNT, NC 27803-1700
(252) 443-0836
(252) 443-0836
Mailing address
1012 SANDBERG LN, ROCKY MOUNT, NC 27803-2253
(252) 443-0836
(252) 443-0836
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/09/2008
Last updated
01/16/2009
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