Organization
COMMUNITY INTERVENTION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEATHER ST.CLAIR (PROGRAM DIRECTOR)
(252) 321-7710
Entity
Organization
Contact information
Practice address
605 LYNNDALE CT STE A, GREENVILLE, NC 27858-5449
(252) 321-7710
(252) 317-0516
Mailing address
PO BOX 30196, GREENVILLE, NC 27833-0196
(252) 321-7710
(252) 317-0516
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301936
—
NC
05
—
8302079
—
NC
Enumeration date
08/26/2009
Last updated
08/26/2009
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