Healthcare Provider Details

I. General information

NPI: 1245359439
Provider Name (Legal Business Name): BRITESMILZ FAMILY & COMMUNITY CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 GREGORY DR
ROANOKE RAPIDS NC
27870-6442
US

IV. Provider business mailing address

PO BOX 86
ROANOKE RAPIDS NC
27870-0086
US

V. Phone/Fax

Practice location:
  • Phone: 252-537-7575
  • Fax: 252-537-9008
Mailing address:
  • Phone: 252-537-7575
  • Fax: 252-537-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVELYN S. DAWSON
Title or Position: DIRECTOR
Credential:
Phone: 252-537-7575