Organization
PROJECT MOMENTUM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYSHA RONCELLE WYNN (EXECUTIVE DIRECTOR)
(252) 314-4363
Entity
Organization
Contact information
Practice address
107 SE MAIN ST STE 410, ROCKY MOUNT, NC 27801-5400
(252) 977-0765
(252) 977-0765
Mailing address
P.O. BOX 4053, ROCK Y MOUNT, NC 27803-4053
(252) 977-0765
(252) 977-0765
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8700467
—
NC
Enumeration date
03/07/2007
Last updated
10/21/2009
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