Organization
PORT HEALTH SERVICES
Active
Other names
PORT Human Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BEAVERS (CREDENTIALING MANAGER)
(919) 210-7661
Entity
Organization
Contact information
Practice address
1309 TATUM DR, NEW BERN, NC 28560-4314
(252) 672-8742
(252) 638-3742
Mailing address
4300 SAPPHIRE CT STE 110, GREENVILLE, NC 27834-9079
(252) 830-7540
(252) 413-0932
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MHL-025-204
NC
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903642
—
NC
05
—
6005885
—
NC
Enumeration date
01/10/2007
Last updated
05/24/2023
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