Healthcare Provider Details

I. General information

NPI: 1598903072
Provider Name (Legal Business Name): PRIMARY HEALTH CHOICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 FAYETTEVILLE RD
LUMBERTON NC
28358-2697
US

IV. Provider business mailing address

PO BOX 159
SAINT PAULS NC
28384-0159
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-3939
  • Fax: 910-738-3938
Mailing address:
  • Phone: 910-865-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY LOCKLEAR
Title or Position: CFO
Credential:
Phone: 910-865-3500