Organization
EAST CAROLINA UNIVERSITY
Active
Other names
Children's Developmental Services Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY JUDSON STAINBACK PHD (DIRECTOR COSA)
(252) 737-1167
Entity
Organization
Contact information
Practice address
IRONS BUILDING-OGLESBY DR., GREENVILLE, NC 27858
(252) 737-1177
(252) 328-4486
Mailing address
IRONS BUILDING-OGLESBY DR., GREENVILLE, NC 27858
(252) 737-1177
(252) 328-4486
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
104100000X
Social Worker
—
—
133N00000X
Nutritionist
—
—
163W00000X
Registered Nurse
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
225100000X
Physical Therapist
—
—
225CA2400X
Assistive Technology Practitioner Rehabilitation Counselor
—
—
225X00000X
Occupational Therapist
—
—
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03411
BCBS
NC
05
—
3403406
—
NC
Enumeration date
03/20/2007
Last updated
07/17/2008
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