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2901 N Herritage St Ste B Kinston NC 28501-1594 | |
| (252) 233-2383 | |
| (252) 523-3148 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2901 N Herritage St Ste B, Kinston, North Carolina |
| Authorized Official Name and Position | Brett Beavers (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9192107661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4300 Sapphire Ct Ste 110 Greenville NC 27834-9079 Ph: (252) 830-7540 | 2901 N Herritage St Ste B Kinston NC 28501-1594 Ph: (252) 233-2383 |
| NPI Number | 1720145535 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 05/24/2023 |
| Certification Date | 05/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720145535 | NPI | - | NPPES |
| 8301050 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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