Provider Demographics
NPI:1457640575
Name:THERAPEUTIC INTERVENTION SERVICES, INC.
Entity Type:Organization
Organization Name:THERAPEUTIC INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DEEVAR
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-258-4362
Mailing Address - Street 1:4803 RED BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9314
Mailing Address - Country:US
Mailing Address - Phone:252-258-4783
Mailing Address - Fax:
Practice Address - Street 1:413 MOUNT CROSS RD STE 106
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4089
Practice Address - Country:US
Practice Address - Phone:252-258-4783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1644251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health