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57635 Nc Highway 12 Hatteras NC 27953 | |
(252) 255-7001 | |
(252) 986-0349 |
Full Name | |
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Speciality | Counselor |
Location | 57635 Nc Highway 12, Hatteras, 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 |
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4300 Sapphire Ct Ste 110 Greenville NC 27834-9079 Ph: (252) 830-7540 | 57635 Nc Highway 12 Hatteras NC 27953 Ph: (252) 255-7001 |
NPI Number | 1417356411 |
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Provider Enumeration Date | 08/15/2014 |
Last Update Date | 06/01/2023 |
Certification Date | 05/24/2023 |
Identifier | Type | State | Issuer |
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1417356411 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101Y00000X | Counselor | (* (Not Available)) | Primary |