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General NPI Number Information
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NPI Number | 1780075952
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Entity Type | Organization
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Legal Business Name | ABC PLAY
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 1290 HALSTEAD BLVD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-5840
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Country | US
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Telephone | 252-333-8445
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Fax | 252-404-9136
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Provider Business Mailing Address
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Address Line | PO BOX 1614
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City | ELIZABETH CITY
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State | NC
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Zip | 27906-1614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | IFTS, LCAS-A
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Name | WILKIAM WILSON
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Credential | BS, MS, ITFS, LCAS-A
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Telephone | 252-312-0516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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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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