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General NPI Number Information
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NPI Number | 1457657645
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Entity Type | Organization
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Legal Business Name | PREMIER BEHAVIORAL SERVICES INC
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 2003 GODWIN AVE SUITE B
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City | LUMBERTON
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State | NC
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Zip | 28358-3197
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Country | US
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Telephone | 910-671-1111
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Fax | 910-671-4454
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Provider Business Mailing Address
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Address Line | 2003 GODWIN AVENUE SUITE B
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City | LUMBERTON
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State | NC
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Zip | 28358-3197
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Country | US
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Telephone | 910-671-1111
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Fax | 910-671-4454
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANTHOSH AUGUSTINE
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Credential | MD
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Telephone | 910-733-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C001816
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9600445
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19520
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License Number State | NC
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Taxonomy #4
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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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