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56 Dodge Ln Smithfield NC 27577-8731 | |
| (910) 403-6106 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 56 Dodge Ln, Smithfield, North Carolina |
| Authorized Official Name and Position | Trevor Aaron Ulrich (OWNER) |
| Authorized Official Contact | 9194036106 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2122 Godwin Lake Rd Benson NC 27504-6335 Ph: (910) 403-6106 | 56 Dodge Ln Smithfield NC 27577-8731 Ph: (910) 403-6106 |
| NPI Number | 1053149476 |
|---|---|
| Provider Enumeration Date | 07/25/2024 |
| Last Update Date | 01/11/2025 |
| Certification Date | 01/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053149476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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