Healthcare Provider Details

I. General information

NPI: 1730350372
Provider Name (Legal Business Name): UPLIFT COMPREHENSIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E ARLINGTON BLVD SUITE F.
GREENVILLE NC
27858-5019
US

IV. Provider business mailing address

PO BOX 1408
ELIZABETH CITY NC
27906-1408
US

V. Phone/Fax

Practice location:
  • Phone: 252-551-5544
  • Fax:
Mailing address:
  • Phone: 252-334-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JOHN TAYLOR
Title or Position: CFO
Credential:
Phone: 252-334-1536