Organization
COMMUNITY INTERVENTION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKIE GORHAM PHILLIPS (CEO PRESIDENT)
(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
101YP2500X
Professional Counselor
—
NC
106H00000X
Marriage & Family Therapist
—
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
NC
Other
Enumeration date
04/19/2007
Last updated
08/23/2007
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