=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396138988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUILDING BRAINS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2015
-----------------------------------------------------
Last Update Date | 03/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2705 FOREST GLEN DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-7197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-917-1279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2705 FOREST GLEN DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-7197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-917-1279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | MRS. HALEY J. MORGAN
-----------------------------------------------------
Credential | LPCA
-----------------------------------------------------
Telephone | 252-917-1279
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------