Organization
MYBROTHERSKEEPER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA JEAN WILSON OWNER (ADMINISTRATOR)
(252) 985-2735
Entity
Organization
Contact information
Practice address
816 PAUL ST, ROCKY MOUNT, NC 27803-3337
(252) 985-2735
(252) 985-1952
Mailing address
816 PAUL ST, ROCKY MOUNT, NC 27803-3337
(252) 985-2735
(252) 985-1952
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
MHL064060
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804401
—
NC
Enumeration date
03/16/2007
Last updated
07/31/2008
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