Healthcare Provider Details

I. General information

NPI: 1558558197
Provider Name (Legal Business Name): POSITIVE FUTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WINFALL BLVD SUITE 3
HERTFORD NC
27944-8829
US

IV. Provider business mailing address

PO BOX 207
WINFALL NC
27985-0207
US

V. Phone/Fax

Practice location:
  • Phone: 252-426-7537
  • Fax: 252-426-1877
Mailing address:
  • Phone: 252-426-7537
  • Fax: 252-426-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS CRYSTAL LYNETTE LEE
Title or Position: OWNER
Credential:
Phone: 252-426-7537