Healthcare Provider Details

I. General information

NPI: 1184411993
Provider Name (Legal Business Name): EARLY IDENTIFICATION EARLY INTERVENTION OUTREACH PROGRAM (EIEIOP)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 NASH ST N STE 168
WILSON NC
27896-1741
US

IV. Provider business mailing address

2302 NASH ST N STE 168
WILSON NC
27896-1741
US

V. Phone/Fax

Practice location:
  • Phone: 252-299-8501
  • Fax: 252-291-3137
Mailing address:
  • Phone: 252-299-8501
  • Fax: 252-291-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VERNA W BOYD
Title or Position: EXECUTIVE DIRECTOR
Credential: REGISTERED NURSE
Phone: 252-299-8501