Provider Demographics
NPI:1033344023
Name:NORTHEASTERN HUMAN SERVICES
Entity Type:Organization
Organization Name:NORTHEASTERN HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-673-1661
Mailing Address - Street 1:6316 SAYBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1282
Mailing Address - Country:US
Mailing Address - Phone:919-878-6764
Mailing Address - Fax:919-878-6764
Practice Address - Street 1:6316 SAYBROOKE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1282
Practice Address - Country:US
Practice Address - Phone:919-878-6764
Practice Address - Fax:919-878-6764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8457098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health