Provider Demographics
NPI:1558558197
Name:POSITIVE FUTURE, LLC
Entity Type:Organization
Organization Name:POSITIVE FUTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-426-7537
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:WINFALL
Mailing Address - State:NC
Mailing Address - Zip Code:27985-0207
Mailing Address - Country:US
Mailing Address - Phone:252-426-7537
Mailing Address - Fax:252-426-1877
Practice Address - Street 1:220 WINFALL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-8829
Practice Address - Country:US
Practice Address - Phone:252-426-7537
Practice Address - Fax:252-426-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
261QM0855X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder