Healthcare Provider Details

I. General information

NPI: 1124191119
Provider Name (Legal Business Name): PREMIER FAMILY HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 HWY 158
ROANOKE RAPIDS NC
27870-8378
US

IV. Provider business mailing address

1704 HWY 158
ROANOKE RAPIDS NC
27870-8378
US

V. Phone/Fax

Practice location:
  • Phone: 252-519-2273
  • Fax: 252-535-2399
Mailing address:
  • Phone: 252-519-2273
  • Fax: 252-535-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACIE MEDLIN SHEARIN
Title or Position: PRESIDENT / OWNER
Credential: MSW
Phone: 252-519-2273