Organization
PROGRAM RESOURCE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THEODORE FITZGERALD (EXECUTIVE DIRECTOR)
(910) 891-7062
Entity
Organization
Contact information
Practice address
2509 FAYETTEVILLE ST, SANFORD, NC 27330
(919) 774-7746
(919) 775-2779
Mailing address
108 N ORANGE AVE, DUNN, NC 28334-3826
(910) 891-7062
(910) 892-3764
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
MHL-053-026
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
MHL-053-026
NC
101YM0800X
Mental Health Counselor
MHL-053-026
NC
Other
Enumeration date
09/26/2007
Last updated
10/17/2007
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