Healthcare Provider Details

I. General information

NPI: 1912952672
Provider Name (Legal Business Name): DREAM PROVIDER CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 STEWART PKWY
WASHINGTON NC
27889-4972
US

IV. Provider business mailing address

216 STEWART PKWY
WASHINGTON NC
27889-4972
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-0585
  • Fax: 252-946-0580
Mailing address:
  • Phone: 252-946-0585
  • Fax: 252-946-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. WENDEE M BAILEY
Title or Position: OWNER
Credential:
Phone: 252-946-0585