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General NPI Number Information
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NPI Number | 1558545806
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Entity Type | Organization
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Legal Business Name | EAST COVE PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 2901 N HERRITAGE ST STE C
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City | KINSTON
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State | NC
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Zip | 28501-1581
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Country | US
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Telephone | 252-523-2781
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Fax | 252-523-2779
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Provider Business Mailing Address
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Address Line | 2901 N HERRITAGE ST STE C
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City | KINSTON
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State | NC
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Zip | 28501-1581
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Country | US
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Telephone | 252-523-2781
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Fax | 252-523-2779
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Authorized Official
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Title or Position | CHILD/ADULT PSYCHIATRIST
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Name | MRS. JOANNA WOLICKI-SHANNON
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Credential | M.D.
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Telephone | 252-523-2781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | NC
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