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General NPI Number Information
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NPI Number | 1942781836
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Entity Type | Organization
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Legal Business Name | CONNECT3 HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 1088 NC HWY 86N
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City | YANCEYVILLE
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State | NC
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Zip | 27379
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Country | US
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Telephone | 336-694-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 2744 RIVERCLIFF RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3372
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Country | US
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Telephone | 910-797-0787
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. GREGORY EUGENE PERKINS
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Credential | EDD, MSW
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Telephone | 910-797-0787
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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 | LCAS-24279
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License Number State | NC
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