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General NPI Number Information
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NPI Number | 1295271039
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Entity Type | Organization
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Legal Business Name | MILESTONE INNOVATIVE SERVICES
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 618 E BOULEVARD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-2736
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Country | US
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Telephone | 252-792-0659
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Fax | 252-792-0660
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Provider Business Mailing Address
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Address Line | 618 E BOULEVARD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-2736
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Country | US
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Telephone | 252-792-0659
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Fax | 252-792-0660
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA MICHELLE MOORE-HARDISON
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Credential | MA, MSW
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Telephone | 252-799-1916
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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 | 3185A
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License Number State | NC
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Taxonomy #2
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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 #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9919
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010046
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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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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