Organization
SEQUEL TSI OF NORTH CAROLINA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN STUPAK (PRESIDENT)
(267) 419-8913
Entity
Organization
Contact information
Practice address
2480 HADLEY MILL RD, PITTSBORO, NC 27312-7832
(919) 542-1104
(919) 542-5565
Mailing address
PO BOX 1370, PITTSBORO, NC 27312-1370
(919) 542-1104
(919) 542-5565
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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