Healthcare Provider Details

I. General information

NPI: 1134832959
Provider Name (Legal Business Name): I FIT OUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MARTIN LUTHER KING JR DR
LUMBERTON NC
28358-5443
US

IV. Provider business mailing address

511 MARTIN LUTHER KING JR DR
LUMBERTON NC
28358-5443
US

V. Phone/Fax

Practice location:
  • Phone: 910-370-0018
  • Fax: 919-820-8551
Mailing address:
  • Phone: 910-370-0018
  • Fax: 919-820-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: EVETTE V WARD SMITH
Title or Position: PRESIDENT
Credential:
Phone: 910-370-0018