Healthcare Provider Details

I. General information

NPI: 1215103650
Provider Name (Legal Business Name): GENERATIONS HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 ATKINSON ST
LAURINBURG NC
28352-4718
US

IV. Provider business mailing address

PO BOX 1887
LAURINBURG NC
28353-1887
US

V. Phone/Fax

Practice location:
  • Phone: 910-291-9909
  • Fax: 910-291-9913
Mailing address:
  • Phone: 910-291-9909
  • Fax: 910-291-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AGYENIM AKUAMOAH-BOATENG
Title or Position: PROGRAM DIRECTOR
Credential: MS, CRC, LCAS, LPC
Phone: 910-291-9909