| Eyes Wyde Shut Inc. | |
|
1209b S York St Gastonia NC 28052-6127 | |
| (980) 777-0801 | |
| Not Available |
| Full Name | Eyes Wyde Shut Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1209b S York St, Gastonia, North Carolina |
| Authorized Official Name and Position | Kinena Dent-smith (FOUNDER) |
| Authorized Official Contact | 9807770801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eyes Wyde Shut Inc. 1964 Slippery Rock Ln Monroe NC 28112-0005 Ph: (980) 777-0801 | Eyes Wyde Shut Inc. 1209b S York St Gastonia NC 28052-6127 Ph: (980) 777-0801 |
| NPI Number | 1508557216 |
|---|---|
| Provider Enumeration Date | 05/15/2023 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508557216 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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