=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043589179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED HUMAN SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2011
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 CAROLINA AVE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27889-3571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-702-4984
-----------------------------------------------------
Fax | 252-948-0059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 N REED DR
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27889-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-702-4984
-----------------------------------------------------
Fax | 252-948-0059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BONITA WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-702-4984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------