Healthcare Provider Details

I. General information

NPI: 1841504263
Provider Name (Legal Business Name): PARADIGM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 S MEMORIAL DR SUITE J&K
WINTERVILLE NC
28590-5839
US

IV. Provider business mailing address

PO BOX 31091
GREENVILLE NC
27833-1091
US

V. Phone/Fax

Practice location:
  • Phone: 252-561-8112
  • Fax: 252-561-7455
Mailing address:
  • Phone: 252-561-8112
  • Fax: 252-561-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON TREMAIN BARNETT
Title or Position: CEO
Credential:
Phone: 252-561-8112