Healthcare Provider Details

I. General information

NPI: 1013391937
Provider Name (Legal Business Name): SUNSHINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 CRUMPTOWN RD
WAGRAM NC
28396-1500
US

IV. Provider business mailing address

23800 CRUMPTOWN ROAD
WAGRAM NC
28396-1500
US

V. Phone/Fax

Practice location:
  • Phone: 910-734-8549
  • Fax: 910-369-0209
Mailing address:
  • Phone: 910-734-8549
  • Fax: 910-369-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: LINDA MCLAUGHLIN
Title or Position: OWNER/CEO
Credential:
Phone: 910-734-8549