| Community Innovations, Inc | |
|
801 Wilson St Whiteville NC 28472-4713 | |
| (910) 642-5697 | |
| Not Available |
| Full Name | Community Innovations, Inc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 801 Wilson St, Whiteville, North Carolina |
| Authorized Official Name and Position | Talesha Rollock (PROVIDER ENROLLMENT SPECIALIST) |
| Authorized Official Contact | 9192560824 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Innovations, Inc 3210 Fairhill Dr Raleigh NC 27612-3215 Ph: (919) 256-0824 | Community Innovations, Inc 801 Wilson St Whiteville NC 28472-4713 Ph: (910) 642-5697 |
| NPI Number | 1003088451 |
|---|---|
| Provider Enumeration Date | 03/26/2008 |
| Last Update Date | 12/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003088451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (North Carolina) | Primary |
| 1041C0700X | Social Worker - Clinical | (North Carolina) | Secondary |
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