Healthcare Provider Details

I. General information

NPI: 1346300464
Provider Name (Legal Business Name): WALTER B JONES ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 W 5TH ST
GREENVILLE NC
27834
US

IV. Provider business mailing address

2577 W 5TH ST
GREENVILLE NC
27834-7813
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-3426
  • Fax: 252-830-8585
Mailing address:
  • Phone: 252-830-3426
  • Fax: 252-830-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE REESE-JOSEFSBERG
Title or Position: UM COORDINATOR
Credential:
Phone: 919-855-4761