Organization
MILESTONE INNOVATIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA MICHELLE MOORE-HARDISON MA, MSW (PRESIDENT)
(252) 799-1916
Entity
Organization
Contact information
Practice address
618 E BOULEVARD, WILLIAMSTON, NC 27892-2736
(252) 792-0659
(252) 792-0660
Mailing address
618 E BOULEVARD, WILLIAMSTON, NC 27892-2736
(252) 792-0659
(252) 792-0660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3185A
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
9919
NC
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
C010046
NC
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1544820
STATE NC
NC
Enumeration date
01/18/2017
Last updated
06/10/2022
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