Healthcare Provider Details

I. General information

NPI: 1780883959
Provider Name (Legal Business Name): PALMER PREVENTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N. MAIN ST.
PEMBROKE NC
28372-3959
US

IV. Provider business mailing address

PO BOX 3959
PEMBROKE NC
28372-3959
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-0421
  • Fax: 910-522-1169
Mailing address:
  • Phone: 910-522-0421
  • Fax: 910-522-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMHL-078-194
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-078-194
License Number StateNC

VIII. Authorized Official

Name: MR. THOMAS GRAHAM NORTON
Title or Position: EX. DIRECTOR
Credential: LCAS, CCS
Phone: 910-522-0421