Organization
JACKSONVILLE BEHAVIOR AND MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADHUR MITTAL MD (PRESIDENT)
(910) 353-0581
Entity
Organization
Contact information
Practice address
156 MEMORIAL CT, JACKSONVILLE, NC 28546-6322
(910) 353-0680
(910) 353-3629
Mailing address
118 MEMORIAL DR, JACKSONVILLE, NC 28546-6328
(910) 353-0581
(910) 939-4269
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
3758
NC
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8901904
—
NC
Enumeration date
10/04/2007
Last updated
07/08/2020
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