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General NPI Number Information
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NPI Number | 1316077043
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Entity Type | Organization
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Legal Business Name | PORT HUMAN SERVICES
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15 IRELAND DRIVE
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City | BAYBORO
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State | NC
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Zip | 28515-0519
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Country | US
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Telephone | 252-745-7789
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Fax | 252-745-7647
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Provider Business Mailing Address
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Address Line | 2245 STANTONSBURG RD SUITE P
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City | GREENVILLE
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State | NC
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Zip | 27834-2868
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Country | US
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Telephone | 252-752-0483
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Fax | 252-752-2971
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Authorized Official
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Title or Position | CEO
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Name | THOMAS SAVIDGE
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Credential |
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Telephone | 252-752-0483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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