Healthcare Provider Details

I. General information

NPI: 1346164811
Provider Name (Legal Business Name): MID STATE HEALTH SYSTYEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 LEGION RD
HOPE MILLS NC
28348-8411
US

IV. Provider business mailing address

3721 LEGION RD
HOPE MILLS NC
28348-8411
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-3717
  • Fax: 910-484-1315
Mailing address:
  • Phone: 910-484-3717
  • Fax: 910-484-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: SERA GILMORE
Title or Position: PRESIDENT
Credential:
Phone: 910-263-3109