Provider Demographics
NPI:1477942472
Name:THE GROWTH CENTER
Entity Type:Organization
Organization Name:THE GROWTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHNIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-876-0251
Mailing Address - Street 1:1603 GODWIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-4207
Mailing Address - Country:US
Mailing Address - Phone:910-608-0003
Mailing Address - Fax:910-608-2225
Practice Address - Street 1:1603 GODWIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4207
Practice Address - Country:US
Practice Address - Phone:910-608-0003
Practice Address - Fax:910-608-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP009177251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health