Organization
SAM/OUTREACH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSALIND TERRELLE BYNUM (EXECUTIVE DIRECTOR)
(704) 740-6512
Entity
Organization
Contact information
Practice address
114 E MAIN ST, STE. B, LINCOLNTON, NC 28092-2725
(704) 740-6512
(704) 735-4995
Mailing address
PO BOX 1710, LINCOLNTON, NC 28093-1710
(704) 740-6512
(704) 735-4995
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MHL-055-114
NC
Other
Enumeration date
12/10/2009
Last updated
12/10/2009
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