Individual
MR. JAMES EDWARD MCIVER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
141 THOMAS HUMPHREY RD, JACKSONVILLE, NC 28546-6205
(910) 347-5218
(910) 346-0957
Mailing address
PO BOX 12364, JACKSONVILLE, NC 28546-2364
(910) 347-5218
(910) 346-0957
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-067-142
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-067-162
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603585
—
NC
05
—
6603978
—
NC
05
—
8301087B
—
NC
Enumeration date
01/22/2007
Last updated
07/09/2007
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