Healthcare Provider Details

I. General information

NPI: 1275926008
Provider Name (Legal Business Name): SEA HOPE EDUCATION & WELLNESS CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLDE WATERFORD WAY SUITE 305
LELAND NC
28451-4125
US

IV. Provider business mailing address

509 OLDE WATERFORD WAY SUITE 305
LELAND NC
28451-4125
US

V. Phone/Fax

Practice location:
  • Phone: 910-515-0611
  • Fax: 888-959-8911
Mailing address:
  • Phone: 910-515-0611
  • Fax: 888-959-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5271
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5272
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number5271
License Number StateNC

VIII. Authorized Official

Name: TWYNA BELL
Title or Position: CLINICAL DIRECTOR
Credential: MA,LPC, PSC
Phone: 910-515-0611