MEDICARE: GREATER VISIONS HEALTHCARE SERVICES, 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	101YP1600X	Pastoral Counselor
2	251B00000X	Case Management Agency
3	320800000X	Mental Illness Community Based Residential Treatment Facility
4	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
5	251C00000X	Developmentally Disabled Services Day Training Agency	MHL-067-194	NC
6	101YA0400X	Addiction (Substance Use Disorder) Counselor	MHL-067-194	NC
7	101YM0800X	Mental Health Counselor
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952535148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER VISIONS HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	2436 ONSLOW DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5608
Country	:	US
Telephone Number	:	910-346-1001
Fax Number	:	910-346-1003

Provider Business Practice Location Address
First Line	:	2436 ONSLOW DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5608
Country	:	US
Telephone Number	:	910-346-1001
Fax Number	:	910-346-1003

Authorized Official
Title or Position	:	CHIEF EXECUTIVE DIRECTOR
Name	:	DR. LINDA DARNELL GARY
Credential	:
Telephone Number	:	910-346-1001

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	09/18/2012

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