Healthcare Provider Details

I. General information

NPI: 1104570613
Provider Name (Legal Business Name): NEW LIFE CHRISTIAN FELLOWSHIP OF CURRITUCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 CARATOKE HWY
BARCO NC
27917-9510
US

IV. Provider business mailing address

4134 CARATOKE HWY
BARCO NC
27917-9510
US

V. Phone/Fax

Practice location:
  • Phone: 252-453-2773
  • Fax:
Mailing address:
  • Phone: 252-453-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL BERGEY
Title or Position: SENIOR PASTOR/FOUNDER
Credential: DR.
Phone: 252-453-2773