Provider Demographics
NPI:1104022847
Name:PROGRAM RESOURCE INSTITUTE, INC.
Entity Type:Organization
Organization Name:PROGRAM RESOURCE INSTITUTE, INC.
Other - Org Name:PRI COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:910-891-7062
Mailing Address - Street 1:108 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3826
Mailing Address - Country:US
Mailing Address - Phone:910-891-7062
Mailing Address - Fax:910-892-3764
Practice Address - Street 1:157 DUBLIN SQUARE RD STE P
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8691
Practice Address - Country:US
Practice Address - Phone:336-626-9091
Practice Address - Fax:336-625-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-076-082101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005904Medicaid