Healthcare Provider Details

I. General information

NPI: 1710347885
Provider Name (Legal Business Name): GOLDEN GATE HUMAN SERVICES AND TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 ROANOKE AVENUE
ROANOKE RAPIDS NC
27870
US

IV. Provider business mailing address

4472 GATWAY DRIVE
WINTERVILLE NC
28590
US

V. Phone/Fax

Practice location:
  • Phone: 252-375-2076
  • Fax:
Mailing address:
  • Phone: 252-375-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MISS FATIMA ABDALLAH ZEITAWI
Title or Position: OWNER
Credential:
Phone: 252-375-2076