Healthcare Provider Details

I. General information

NPI: 1861104317
Provider Name (Legal Business Name): OUR PROMISES KEPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1910 SANDY RIDGE CHURCH RD
MORVEN NC
28119-9469
US

IV. Provider business mailing address

PO BOX 604
WADESBORO NC
28170-0604
US

V. Phone/Fax

Practice location:
  • Phone: 910-975-5535
  • Fax: 704-826-8922
Mailing address:
  • Phone: 910-975-5535
  • Fax: 704-826-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WENDELL LITTLE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 910-795-4454