Healthcare Provider Details

I. General information

NPI: 1740431907
Provider Name (Legal Business Name): BIGMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W EHRINGHAUS ST SUITE A
ELIZABETH CITY NC
27909-6970
US

IV. Provider business mailing address

905 W EHRINGHAUS ST SUITE A
ELIZABETH CITY NC
27909-6970
US

V. Phone/Fax

Practice location:
  • Phone: 252-337-7700
  • Fax:
Mailing address:
  • Phone: 252-337-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC006125
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006125
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC006125
License Number StateNC

VIII. Authorized Official

Name: PROF. CAROL A DAVIS
Title or Position: DIRECTOR
Credential: LCSW
Phone: 252-337-7700