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General NPI Number Information
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NPI Number | 1770585077
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Entity Type | Organization
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Legal Business Name | PRI CONTRACT SERVICES, INC.
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 211 CHATHAM ST
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City | SANFORD
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State | NC
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Zip | 27330-4336
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Country | US
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Telephone | 919-774-7746
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Fax | 919-775-2779
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Provider Business Mailing Address
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Address Line | PO BOX 747
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City | LILLINGTON
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State | NC
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Zip | 27546-0747
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Country | US
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Telephone | 910-814-0394
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Fax | 910-814-0395
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. THEODORE CURTIS FIZTGERALD
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Credential | M.S.
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Telephone | 910-814-0394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 053-026
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License Number State | NC
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