MEDICARE: DREAM PROVIDER CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor
3	251S00000X	Community/Behavioral Health Agency	MHL007036	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659651719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM PROVIDER CARE SERVICES

Provider Business Mailing Address
First Line	:	216 STEWART PARKWAY
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-4972
Country	:	US
Telephone Number	:	252-946-0585
Fax Number	:	252-946-0580

Provider Business Practice Location Address
First Line	:	716 WASHINGTON STREET
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-2222
Country	:	US
Telephone Number	:	252-946-0585
Fax Number	:	252-946-0580

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ADREANNE TURNER
Credential	:	BA
Telephone Number	:	252-946-0585

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	01/13/2020

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Directions to “DREAM PROVIDER CARE SERVICES ” Practice Location

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