Provider Demographics
NPI:1619155165
Name:ELOHIM COUNSELING AND RESOURCE CENTER
Entity Type:Organization
Organization Name:ELOHIM COUNSELING AND RESOURCE CENTER
Other - Org Name:THE RIVER HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-4074
Mailing Address - Street 1:120 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4128
Mailing Address - Country:US
Mailing Address - Phone:252-758-4245
Mailing Address - Fax:
Practice Address - Street 1:1710 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1669
Practice Address - Country:US
Practice Address - Phone:252-758-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL074188302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization