Provider Demographics
NPI:1578333191
Name:PRO-HEALTH BEHAVIORAL SERVICES PLLC
Entity Type:Organization
Organization Name:PRO-HEALTH BEHAVIORAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROKIMA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:910-352-4060
Mailing Address - Street 1:4901 BRENTON CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2341
Mailing Address - Country:US
Mailing Address - Phone:910-352-4060
Mailing Address - Fax:
Practice Address - Street 1:4901 BRENTON CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2341
Practice Address - Country:US
Practice Address - Phone:910-352-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty