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General NPI Number Information
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NPI Number | 1033885355
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Entity Type | Organization
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Legal Business Name | MT OLIVE CHURCH OF CHRIST
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 426 HAUGHTON RD
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City | EDENTON
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State | NC
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Zip | 27932-9464
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Country | US
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Telephone | 252-482-1540
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 661
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City | EDENTON
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State | NC
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Zip | 27932-0661
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Country | US
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Telephone | 252-482-1540
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Fax |
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Authorized Official
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Title or Position | PASTOR
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Name | MITCHELL G WYNN
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Credential | PASTORAL COUNSELOR
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Telephone | 252-484-2286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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