Healthcare Provider Details

I. General information

NPI: 1063644730
Provider Name (Legal Business Name): NEW HOPE BEHAVIORAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GREEN ST STE 205
WILLIAMSTON NC
27892-2066
US

IV. Provider business mailing address

200 GREEN ST STE 205
WILLIAMSTON NC
27892-2066
US

V. Phone/Fax

Practice location:
  • Phone: 252-792-7229
  • Fax: 252-792-7229
Mailing address:
  • Phone: 252-792-7229
  • Fax: 252-792-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1980
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3822
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DION SMALLWOOD
Title or Position: CEO
Credential:
Phone: 252-792-7229