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Organization
STEPHENS OUTREACH CENTER, INC
Active
Organization
STEPHENS OUTREACH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN J STEPHENS SR. (CEO)
(910) 308-4847
Entity
Organization
Contact information
Practice address
105 W 5TH ST, TABOR CITY, NC 28463-1923
(910) 653-5553
Mailing address
105 W 5TH ST, TABOR CITY, NC 28463-1923
(910) 653-5553
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL078149
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006568
—
NC
05
—
6604154
—
NC
05
—
8301487B
—
NC
Enumeration date
12/22/2008
Last updated
12/22/2008
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