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Organization
STATEWIDE MENTAL HEALTH & DISABILITY SERVICES, PLLC
Active
Organization
STATEWIDE MENTAL HEALTH & DISABILITY SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTIN CLAYTON MSW, LCSW (CEO)
(252) 308-1247
Entity
Organization
Contact information
Practice address
64 KNIGHT RD, HOLLISTER, NC 27844-9791
(252) 308-1247
(252) 308-1248
Mailing address
730 ROANOKE AVENUE, SUITE A-1, ROANOKE RAPIDS, NC 27870-2740
(252) 308-1247
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34782
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6003794
—
NC
Enumeration date
03/31/2014
Last updated
07/31/2017
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