Provider Demographics
NPI:1356492359
Name:BODY WHOLE HEALTH AND COUNSELING
Entity Type:Organization
Organization Name:BODY WHOLE HEALTH AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-293-9966
Mailing Address - Street 1:PO BOX 7626
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-7626
Mailing Address - Country:US
Mailing Address - Phone:252-293-9966
Mailing Address - Fax:252-293-9967
Practice Address - Street 1:103 BRENTWOOD CENTER LN N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1710
Practice Address - Country:US
Practice Address - Phone:252-293-9966
Practice Address - Fax:252-293-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003025251S00000X
NC32314251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901994Medicaid
NC8703105Medicaid
NC3410103Medicaid
NC8301384DMedicaid
NC6003801Medicaid
NC8301384Medicaid
NC8301384HMedicaid
NC2349022AMedicare ID - Type Unspecified
NC8301384DMedicaid