Provider Demographics
NPI:1447567060
Name:DREAM PROVIDER CARE SERVICES
Entity Type:Organization
Organization Name:DREAM PROVIDER CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-946-0585
Mailing Address - Street 1:216 STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4972
Mailing Address - Country:US
Mailing Address - Phone:252-946-0585
Mailing Address - Fax:252-946-0580
Practice Address - Street 1:216 STEWART PKWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4972
Practice Address - Country:US
Practice Address - Phone:252-946-0585
Practice Address - Fax:252-946-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005782Medicaid