Provider Demographics
NPI:1609105592
Name:PREMIER BEHAVIORAL SERVICES INC
Entity Type:Organization
Organization Name:PREMIER BEHAVIORAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3150
Mailing Address - Country:US
Mailing Address - Phone:910-671-1111
Mailing Address - Fax:910-671-4454
Practice Address - Street 1:104 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-1665
Practice Address - Country:US
Practice Address - Phone:910-653-3040
Practice Address - Fax:910-653-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 024 082251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health