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General NPI Number Information
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NPI Number | 1265546030
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Entity Type | Organization
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Legal Business Name | PROGRAM RESOURCE INSTITUTE, INC.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 157 DUBLIN SQUARE RD STE P
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City | ASHEBORO
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State | NC
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Zip | 27203-8691
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Country | US
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Telephone | 336-626-9091
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Fax | 336-625-3720
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Provider Business Mailing Address
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Address Line | 108 N ORANGE AVE
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City | DUNN
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State | NC
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Zip | 28334-3826
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Country | US
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Telephone | 910-891-7062
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Fax | 910-892-3764
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TED FITZGERALD
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Credential | M.S.
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Telephone | 910-891-7062
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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 | MHL-076-082
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MHL-076-082
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-076-082
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License Number State | NC
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