Healthcare Provider Details

I. General information

NPI: 1952900615
Provider Name (Legal Business Name): EASTERN TRAUMA & RECOVERY COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11814 US 64A
SPRING HOPE NC
27882-9637
US

IV. Provider business mailing address

11814 US 64A
SPRING HOPE NC
27882-9637
US

V. Phone/Fax

Practice location:
  • Phone: 252-903-5594
  • Fax: 252-303-0616
Mailing address:
  • Phone: 252-903-5594
  • Fax: 252-303-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHARLOTTE HORTON MOSS
Title or Position: OWNER/THERAPIST
Credential: LCAS-A; CCTP; CFTP
Phone: 252-903-5594