Healthcare Provider Details

I. General information

NPI: 1770603516
Provider Name (Legal Business Name): TARHEEL YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6543 US 264 E
GREENVILLE NC
27834-7538
US

IV. Provider business mailing address

6543 US 264 E
GREENVILLE NC
27834-7538
US

V. Phone/Fax

Practice location:
  • Phone: 252-341-5860
  • Fax: 252-830-9593
Mailing address:
  • Phone: 252-830-9593
  • Fax: 252-830-9593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW SCOTT GODDARD
Title or Position: PARTNER
Credential:
Phone: 252-341-5860