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General NPI Number Information
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NPI Number | 1972094902
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Entity Type | Organization
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Legal Business Name | EAGLE VISION EMPOWERMENT SERVICES
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 1101 S ANDREWS AVE
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City | GOLDSBORO
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State | NC
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Zip | 27530-6622
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Country | US
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Telephone | 904-853-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 S ANDREWS AVE
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City | GOLDSBORO
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State | NC
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Zip | 27530-6622
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Country | US
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Telephone | 919-892-6614
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Fax | 919-289-1490
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. COURTENAY Y HALL
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Credential | LCSW
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Telephone | 919-892-6614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW14380
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License Number State | FL
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