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General NPI Number Information
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NPI Number | 1407977390
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Entity Type | Organization
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Legal Business Name | STEPHENS OUTREACH CENTER, INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 405 DUNN RD # A
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City | LUMBERTON
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State | NC
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Zip | 28358-7913
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Country | US
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Telephone | 910-738-7865
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1462
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City | FAIRMONT
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State | NC
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Zip | 28340-1110
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Country | US
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Telephone | 910-308-4847
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MELVIN J STEPHENS
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Credential |
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Telephone | 910-308-4847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 251B00000X
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License Number State | NC
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Taxonomy #2
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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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