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Organization
SUPREME TEENS, L&C
Active
Organization
SUPREME TEENS, L&C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVATHAN MARQUETTE EL (DIRECTOR/COORDINATOR)
(252) 467-3407
Entity
Organization
Contact information
Practice address
14495 HWY 301 N., ENFIELD, NC 27823
(252) 467-3407
(252) 445-1073
Mailing address
14495 HWY 301 N., ENFIELD, NC 27823
(252) 467-3407
(252) 445-1073
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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