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General NPI Number Information
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NPI Number | 1366150906
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Entity Type | Organization
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Legal Business Name | P R HEALTH SERVICES OF NC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 3208 SUNSET AVE STE C
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3590
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Country | US
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Telephone | 919-348-7784
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 SUNSET AVE STE C
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3590
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Country | US
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Telephone | 919-348-7784
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Fax |
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR
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Name | MRS. AVIS REGINA MITCHELL
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Credential | BSW,MA,QP,CDAC
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Telephone | 919-348-7784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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 | 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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