Provider Demographics
NPI:1629223565
Name:PROCURE THERAPEUTIC AGENCY, INC
Entity Type:Organization
Organization Name:PROCURE THERAPEUTIC AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:FRIERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-910-1122
Mailing Address - Street 1:PO BOX 620157
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0102
Mailing Address - Country:US
Mailing Address - Phone:704-910-1122
Mailing Address - Fax:704-910-1139
Practice Address - Street 1:2301 W MOREHEAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5271
Practice Address - Country:US
Practice Address - Phone:704-910-1122
Practice Address - Fax:704-910-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008198Medicaid
NC3410183Medicaid
NC5915392Medicaid
NC8302580Medicaid