| East Cove Psychiatric Services Pc | |
|
1305 N Queen St Kinston NC 28501-2965 | |
| (252) 523-2781 | |
| (252) 523-2711 |
| Full Name | East Cove Psychiatric Services Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1305 N Queen St, Kinston, North Carolina |
| Authorized Official Name and Position | Walter Daniel Shannon (OWNER/M.D.) |
| Authorized Official Contact | 2525232781 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Cove Psychiatric Services Pc 1305 N Queen St Kinston NC 28501-2965 Ph: (252) 523-2781 | East Cove Psychiatric Services Pc 1305 N Queen St Kinston NC 28501-2965 Ph: (252) 523-2781 |
| NPI Number | 1801070719 |
|---|---|
| Provider Enumeration Date | 12/27/2007 |
| Last Update Date | 11/05/2010 |
| Medicare PECOS PAC ID | 0547332579 |
|---|---|
| Medicare Enrollment ID | O20080708000180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801070719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 200301170 (North Carolina) | Primary |
| Provider Name | Joanna Wolicki-shannon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245240969 PECOS PAC ID: 4385612290 Enrollment ID: I20040920000202 |
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