Organization
A SMALL TOKEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES HAROLD RANDOLPH (OWNER)
(252) 916-3173
Entity
Organization
Contact information
Practice address
2405 JONES ST, WINTERVILLE, NC 28590-8878
(252) 916-3173
Mailing address
2405 JONES ST, WINTERVILLE, NC 28590-8878
(252) 916-3173
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/01/2012
Last updated
06/01/2012
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