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General NPI Number Information
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NPI Number | 1871810341
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Entity Type | Organization
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Legal Business Name | SOUTHEAST COMMUNITY OUTREACH LLC
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 206 ENTERPRISE ST
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City | CHADBOURN
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State | NC
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Zip | 28431-2104
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Country | US
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Telephone | 919-824-6339
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Fax | 800-595-4571
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Provider Business Mailing Address
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Address Line | PO BOX 161
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City | WHITEVILLE
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State | NC
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Zip | 28472-0161
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Country | US
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Telephone | 919-824-6339
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Fax | 800-595-4571
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | THERIC HOLT
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Credential | B.S., QP
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Telephone | 919-824-6339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NC
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