MEDICARE: EARLY ADOLESCENT INTERVENTION 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740415637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY ADOLESCENT INTERVENTION SERVICES

Provider Business Mailing Address
First Line	:	3175 BOARDWALK LN
Second Line	:	APT. 6
City	:	GREENVILLE
State	:	NC
Zip	:	27834-6196
Country	:	US
Telephone Number	:	252-258-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 BOARDWALK LN
Second Line	:	APT. 6
City	:	GREENVILLE
State	:	NC
Zip	:	27834-6196
Country	:	US
Telephone Number	:	252-258-3000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	MS. SHAMELYA ENGLAND
Credential	:
Telephone Number	:	252-258-3000

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	08/12/2014

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