Organization
CHRYSALIS FOUNDATION FOR MENTAL HEALTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERSON DOUGLAS PARKER (ACTING EXECUTIVE DIRECTOR)
(919) 933-0828
Entity
Organization
Contact information
Practice address
211 WEBB ST, ROXBORO, NC 27573-5338
(336) 599-6030
Mailing address
101 E WEAVER ST, SUITE G-7, CARRBORO, NC 27510-2370
(919) 933-0770
(919) 933-0767
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-073-031
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301148
—
NC
05
—
8301148S
—
NC
Enumeration date
02/12/2007
Last updated
07/17/2007
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