Organization
AMERICORP BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IGNACIO KIRK (CEO)
(919) 696-6071
Entity
Organization
Contact information
Practice address
304 W MILLBROOK RD STE F, RALEIGH, NC 27609-4381
(919) 329-2630
Mailing address
1320 MAIN ST STE 300, COLUMBIA, SC 29201-3266
(919) 696-6071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C 000396
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-09-2503
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6003085
—
NC
Enumeration date
10/05/2014
Last updated
03/30/2015
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