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608 Jackson St Ste 216n Roanoke Rapids NC 27870-2600 | |
| (919) 200-5217 | |
| (252) 650-2214 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 608 Jackson St Ste 216n, Roanoke Rapids, North Carolina |
| Authorized Official Name and Position | Keith Poche (CEO/CLINICIAN) |
| Authorized Official Contact | 9192005217 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
608 Jackson St Ste 212 Roanoke Rapids NC 27870-2600 Ph: (919) 200-5217 | 608 Jackson St Ste 216n Roanoke Rapids NC 27870-2600 Ph: (919) 200-5217 |
| NPI Number | 1215590112 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215590112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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