Provider Demographics
NPI:1407999899
Name:ROANOKE RAPIDS GRADED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ROANOKE RAPIDS GRADED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:252-519-7108
Mailing Address - Street 1:536 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2702
Mailing Address - Country:US
Mailing Address - Phone:252-519-7108
Mailing Address - Fax:252-535-5919
Practice Address - Street 1:536 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2702
Practice Address - Country:US
Practice Address - Phone:252-519-7108
Practice Address - Fax:252-535-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0693103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty