MEDICARE: BIGMERICA INC

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	C006125	NC
2	101YM0800X	Mental Health Counselor	C006125	NC
3	1041C0700X	Clinical Social Worker	C006125	NC

General Provider Information

NPI Number	:	1740431907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIGMERICA INC

Provider Business Mailing Address
First Line	:	905 W EHRINGHAUS ST
Second Line	:	SUITE A
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6970
Country	:	US
Telephone Number	:	252-337-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 W EHRINGHAUS ST
Second Line	:	SUITE A
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-6970
Country	:	US
Telephone Number	:	252-337-7700
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PROF. CAROL A DAVIS
Credential	:	LCSW
Telephone Number	:	252-337-7700

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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Directions to “BIGMERICA INC ” Practice Location

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