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General NPI Number Information
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NPI Number | 1851002794
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Entity Type | Organization
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Legal Business Name | SNAPBACK NC, CO.
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 703 N BROAD ST
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City | EDENTON
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State | NC
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Zip | 27932-1430
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Country | US
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Telephone | 252-698-1389
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Fax |
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Provider Business Mailing Address
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Address Line | 703 N BROAD ST
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City | EDENTON
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State | NC
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Zip | 27932-1430
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Country | US
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Telephone | 252-698-1389
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Fax | 252-368-1529
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. COURTNEY LAYNE BUTLER
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Credential | NCCPSS
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Telephone | 252-260-9406
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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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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