| Prosource Therapeutics, Llc | |
|
201 E Pitt St Tarboro NC 27886-5192 | |
| (252) 353-7025 | |
| Not Available |
| Full Name | Prosource Therapeutics, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 201 E Pitt St, Tarboro, North Carolina |
| Authorized Official Name and Position | Felicia 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 Ste A Greenville NC 27858-9720 Ph: (252) 353-7025 | Prosource Therapeutics, Llc 201 E Pitt St Tarboro NC 27886-5192 Ph: (252) 353-7025 |
| NPI Number | 1720225014 |
|---|---|
| Provider Enumeration Date | 01/08/2009 |
| Last Update Date | 01/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720225014 | NPI | - | NPPES |
| 017PN | Other | NC | NC BLUE CROSS BLUE SHIELD |
| 6005734 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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