Organization
EAST CAROLINA HEALTH
Active
Other names
Northside Behavioral Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON GRAHAM (CFO)
(252) 209-3610
Entity
Organization
Contact information
Practice address
111 HERTFORD COUNTY HIGH RD, AHOSKIE, NC 27910-8131
(252) 209-3170
Mailing address
PO BOX 1385, AHOSKIE, NC 27910-1385
(252) 209-3170
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
H0001
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0256L
BCBS PSYCH PROF. #
NC
05
—
8902806
—
NC
Enumeration date
02/16/2007
Last updated
04/01/2008
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