Prosource Therapeutics Llc | |
102 Fox Haven Dr Suite A Greenville NC 27858-7100 | |
(252) 353-7025 | |
(252) 353-7028 |
Full Name | Prosource Therapeutics Llc |
---|---|
Speciality | Counselor - Professional |
Location | 102 Fox Haven Dr, Greenville, North Carolina |
Authorized Official Name and Position | Phyllis Saunders Smith (ADMINISTRATOR) |
Authorized Official Contact | 2523537025 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Prosource Therapeutics Llc 102 Fox Haven Dr Suite A Greenville NC 27858-7100 Ph: (252) 353-7025 | Prosource Therapeutics Llc 102 Fox Haven Dr Suite A Greenville NC 27858-7100 Ph: (252) 353-7025 |
NPI Number | 1992758429 |
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Provider Enumeration Date | 05/18/2006 |
Last Update Date | 03/26/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992758429 | NPI | - | NPPES |
017PN | Other | NC | NC BLUE CROSS BLUE SHIELD |
6005734 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 2971 (North Carolina) | Primary |
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