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General NPI Number Information
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NPI Number | 1245881366
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Entity Type | Organization
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Legal Business Name | POSITIVE GENERATION IN CHRIST, INCORPORATED
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 608 GREGG AVE # 102103
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City | FLORENCE
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State | SC
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Zip | 29501-4317
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Country | US
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Telephone | 252-641-4522
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Fax | 252-641-5461
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Provider Business Mailing Address
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Address Line | PO BOX 1634
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City | TARBORO
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State | NC
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Zip | 27886-1634
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Country | US
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Telephone | 252-641-4522
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Fax | 252-641-5461
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | IMMACULA SAINT LOUIS
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Credential | MD
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Telephone | 843-879-4763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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