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General NPI Number Information
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NPI Number | 1700425501
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Entity Type | Organization
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Legal Business Name | SURE FOUNDATION BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 3219 LANDMARK ST STE 3A
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City | GREENVILLE
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State | NC
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Zip | 27834-7688
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Country | US
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Telephone | 252-215-3089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8211
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City | GREENVILLE
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State | NC
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Zip | 27835-8211
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Country | US
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Telephone | 252-215-3089
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. GALE BATTS SHIVER
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Credential | BA,MS,LCAS,CCS,MAC,S
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Telephone | 252-215-3089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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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