| Evergreen Behavioral Management, Inc. | |
|
1911 S 17th St Suite 100 Wilmington NC 28401-6662 | |
| (910) 791-9625 | |
| (910) 792-9799 |
| Full Name | Evergreen Behavioral Management, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1911 S 17th St, Wilmington, North Carolina |
| Authorized Official Name and Position | Ginger G Gore (OWNER) |
| Authorized Official Contact | 9106405512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Behavioral Management, Inc. Po Box 425 Whiteville NC 28472-0425 Ph: (910) 640-5512 | Evergreen Behavioral Management, Inc. 1911 S 17th St Suite 100 Wilmington NC 28401-6662 Ph: (910) 791-9625 |
| NPI Number | 1497994099 |
|---|---|
| Provider Enumeration Date | 02/05/2009 |
| Last Update Date | 03/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497994099 | NPI | - | NPPES |
| 8300538 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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