Organization
PRIME AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE JOHNSON (PRESIDENT/OWNER)
(252) 714-2369
Entity
Organization
Contact information
Practice address
111 E 3RD ST, GREENVILLE, NC 27858-1803
(252) 714-2369
Mailing address
111 E 3RD ST STE 2, GREENVILLE, NC 27858-1803
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
NC
324500000X
Substance Abuse Rehabilitation Facility
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261QM0801X
—
NC
Enumeration date
08/07/2011
Last updated
08/07/2011
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