Enroll in NC-PAL | NC Maternal Mental Health MATTERS

Providers must be enrolled in NC MATTERS before they can use the consultation line. Please complete the form below if you would like to learn more about enrolling in NC-PAL. A Care Coordinator will get in touch with you.

Name*
First Middle Last
What type of provider are you?*
What is the name of the practice where you work?*
What is the address of the practice?
Street Address Address Line 2 City State ZIP Code
What county is the practice located in?
What is your email address?*
What is your phone number?