Provider Demographics
NPI:1225777071
Name:EARTHEN VESSELS BEHAVIOR HEALTH CARE
Entity Type:Organization
Organization Name:EARTHEN VESSELS BEHAVIOR HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-340-4641
Mailing Address - Street 1:1960 WALNUT OVERLOOK WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6860
Mailing Address - Country:US
Mailing Address - Phone:910-340-4641
Mailing Address - Fax:
Practice Address - Street 1:1960 WALNUT OVERLOOK WAY APT 303
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6860
Practice Address - Country:US
Practice Address - Phone:910-340-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health