Healthcare Provider Details

I. General information

NPI: 1790973097
Provider Name (Legal Business Name): ELOHIM COUNSELING AND RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W 3RD ST
GREENVILLE NC
27834-1669
US

IV. Provider business mailing address

755 JOHNS HOPKINS DR
GREENVILLE NC
27834-7221
US

V. Phone/Fax

Practice location:
  • Phone: 252-695-6414
  • Fax:
Mailing address:
  • Phone: 252-695-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHEILA PATRICIA INGRAM-CAMERON
Title or Position: PRESIDENT
Credential:
Phone: 252-695-6414