Provider Demographics
NPI:1114115342
Name:EVERGREEN BEHAVORIAL HEALTH
Entity Type:Organization
Organization Name:EVERGREEN BEHAVORIAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSTENHOLME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-9420
Mailing Address - Street 1:220 WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2188
Mailing Address - Country:US
Mailing Address - Phone:910-738-9420
Mailing Address - Fax:910-671-9414
Practice Address - Street 1:220 WINTERGREEN DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2188
Practice Address - Country:US
Practice Address - Phone:910-738-9420
Practice Address - Fax:910-671-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005843251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health