MEDICARE: DREAM BIG 1 CONTINUUM OF CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP1600X	Pastoral Counselor
2	251S00000X	Community/Behavioral Health Agency
3	261Q00000X	Clinic/Center
4	261QP2400X	Prison Health Clinic/Center
5	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

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	:	1770353914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM BIG 1 CONTINUUM OF CARE

Provider Business Mailing Address
First Line	:	2105 PRESBYTERIAN LN # 1002
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-2265
Country	:	US
Telephone Number	:	252-470-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E PENN SQ STE 400
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3310
Country	:	US
Telephone Number	:	267-857-9734
Fax Number	:	909-443-9497

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	LATASHA CARR
Credential	:	LPC, JD
Telephone Number	:	252-470-7236

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “DREAM BIG 1 CONTINUUM OF CARE ” Practice Location

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