Healthcare Provider Details

I. General information

NPI: 1932394632
Provider Name (Legal Business Name): POTTER'S HOUSE OF BEAUFORT COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E 11TH ST
WASHINGTON NC
27889-3716
US

IV. Provider business mailing address

405 N MARKET ST
WASHINGTON NC
27889-4935
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-6390
  • Fax: 252-946-3847
Mailing address:
  • Phone: 252-946-6390
  • Fax: 252-946-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL 007 031
License Number StateNC

VIII. Authorized Official

Name: MRS. TONYA WOOLARD
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 252-946-6390