Provider Demographics
NPI:1619095205
Name:POSITIVE CONNECTION
Entity Type:Organization
Organization Name:POSITIVE CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:252-217-7384
Mailing Address - Street 1:151 WILKINS DR
Mailing Address - Street 2:
Mailing Address - City:ROPER
Mailing Address - State:NC
Mailing Address - Zip Code:27970-9036
Mailing Address - Country:US
Mailing Address - Phone:252-793-3862
Mailing Address - Fax:252-793-7530
Practice Address - Street 1:412 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1417
Practice Address - Country:US
Practice Address - Phone:252-793-5131
Practice Address - Fax:252-793-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty