1952900615 NPI number — EASTERN TRAUMA & RECOVERY COUNSELING SERVICE

Table of content: ROBBIE JEFFERSON JOSEPH M.D. (NPI 1114122173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952900615 NPI number — EASTERN TRAUMA & RECOVERY COUNSELING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN TRAUMA & RECOVERY COUNSELING SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952900615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11814 US 64A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HOPE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27882-9637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-903-5594
Provider Business Mailing Address Fax Number:
252-303-0616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11814 US 64A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HOPE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27882-9637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-903-5594
Provider Business Practice Location Address Fax Number:
252-303-0616
Provider Enumeration Date:
10/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
HORTON
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
252-903-5594

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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