Provider Demographics
NPI:1457657645
Name:PREMIER BEHAVIORAL SERVICES INC
Entity Type:Organization
Organization Name:PREMIER BEHAVIORAL SERVICES INC
Other - Org Name:PREMIER BEHAVIORAL SERVICES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTHOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-733-2007
Mailing Address - Street 1:2003 GODWIN AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3197
Mailing Address - Country:US
Mailing Address - Phone:910-671-1111
Mailing Address - Fax:910-671-4454
Practice Address - Street 1:2003 GODWIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3197
Practice Address - Country:US
Practice Address - Phone:910-671-1111
Practice Address - Fax:910-671-4454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER BEHAVIORAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0018161041C0700X
NC9600445207R00000X
NC195202084P0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty