Organization
PROSOURCE THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FELICIA SMITH (ADMINISTRATOR)
(252) 353-7025
Entity
Organization
Contact information
Practice address
201 E PITT ST, TARBORO, NC 27886-5192
(252) 353-7025
Mailing address
102 FOX HAVEN DR STE A, GREENVILLE, NC 27858-9720
(252) 353-7025
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017PN
NC BLUE CROSS BLUE SHIELD
NC
05
—
6005734
—
NC
Enumeration date
01/08/2009
Last updated
01/08/2009
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