MEDICARE: PRI CONTRACT SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	053-026	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770585077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRI CONTRACT SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 747
Second Line	:
City	:	LILLINGTON
State	:	NC
Zip	:	27546-0747
Country	:	US
Telephone Number	:	910-814-0394
Fax Number	:	910-814-0395

Provider Business Practice Location Address
First Line	:	211 CHATHAM ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4336
Country	:	US
Telephone Number	:	919-774-7746
Fax Number	:	919-775-2779

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. THEODORE CURTIS FIZTGERALD
Credential	:	M.S.
Telephone Number	:	910-814-0394

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/28/2007

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