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Organization
PRIDE IN NORTH CAROLINA, LLC
Active
Organization
PRIDE IN NORTH CAROLINA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON RUTSKI (DIRECTOR OF BUSINESS OPERATIONS)
(910) 452-1460
Entity
Organization
Contact information
Practice address
231 COMMERCE ST, GREENVILLE, NC 27858-5029
(252) 321-8080
Mailing address
231 COMMERCE ST, GREENVILLE, NC 27858-5029
(252) 321-8080
(252) 321-7999
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
MHL-067-186
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017E1
BCBSNC
NC
01
—
225175471
HUMANA GOLD CHOICE
NC
01
—
333347
HEALTH CHOICE
NC
05
—
3410008
—
NC
05
—
341008
—
NC
05
—
5900421
—
NC
05
—
6005302
—
NC
05
—
6005354
—
NC
05
—
6005355
—
NC
05
—
6005356
—
NC
05
—
6006644
—
NC
05
—
6006660
—
NC
05
—
8300244
—
NC
05
—
8300244B
—
NC
05
—
8300244G
—
NC
05
—
8300244H
—
NC
05
—
8300245
—
NC
05
—
8300245B
—
NC
05
—
8300245G
—
NC
05
—
8300245H
—
NC
05
—
8300246
—
NC
05
—
8300246B
—
NC
05
—
8300246G
—
NC
05
—
8300246H
—
NC
05
—
8300247
—
NC
05
—
8300247B
—
NC
05
—
8300247G
—
NC
05
—
8300247H
—
NC
05
—
8300338
—
NC
05
—
8300338B
—
NC
05
—
8300338H
—
NC
05
—
8300581
—
NC
05
—
8300581B
—
NC
05
—
8300581G
—
NC
05
—
8300581H
—
NC
05
—
8303103
—
NC
05
—
8703008
—
NC
Enumeration date
06/04/2006
Last updated
08/19/2024
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