Organization
COLONY BEHAVIORAL HEALTH GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BETHANNE THUMM JACOBSON PH.D. (LICENSED PSYCHOLOGIST)
(252) 636-0112
Entity
Organization
Contact information
Practice address
2804 VILLAGE WAY, TRENT WOODS, NC 28562-7305
(252) 636-0112
(252) 634-9778
Mailing address
2804 VILLAGE WAY, TRENT WOODS, NC 28562-7305
(252) 636-0112
(252) 634-9778
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC1030
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
PCAS28
NC
103TC0700X
Clinical Psychologist
2021
NC
103TC1900X
Counseling Psychologist
Primary
3037
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0197Q
BLUE CROSS BLUE SHEILD
NC
05
—
6006464
—
NC
Enumeration date
05/18/2006
Last updated
06/25/2009
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