Organization
PROGRAM RESOURCE INSTITUTE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TED FITZGERALD M.S. (EXECUTIVE DIRECTOR)
(910) 891-7062
Entity
Organization
Contact information
Practice address
113 W ELWOOD AVE, RAEFORD, NC 28376-2801
(910) 878-0112
(910) 875-6703
Mailing address
108 N ORANGE AVE, DUNN, NC 28334-3826
(910) 891-7062
(910) 892-3467
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MHL-047-099
NC
251B00000X
Case Management Agency
Primary
MHL-047-099
NC
251S00000X
Community/Behavioral Health Agency
MHL-047-099
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301417
—
NC
05
—
8301417B
—
NC
05
—
8301417G
—
NC
05
—
8301418Q
—
NC
01
—
MHL-047-099
DFS LICENSE NBR.
NC
Enumeration date
08/18/2006
Last updated
01/15/2009
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