Organization
PROSOURCE THERAPEUTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS SAUNDERS SMITH (ADMINISTRATOR)
(252) 353-7025
Entity
Organization
Contact information
Practice address
102 FOX HAVEN DR, SUITE A, GREENVILLE, NC 27858-7100
(252) 353-7025
(252) 353-7028
Mailing address
102 FOX HAVEN DR, SUITE A, GREENVILLE, NC 27858-7100
(252) 353-7025
(252) 353-7028
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2971
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017PN
NC BLUE CROSS BLUE SHIELD
NC
05
—
6005734
—
NC
Enumeration date
05/18/2006
Last updated
03/26/2009
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