Provider Demographics
NPI:1639438948
Name:THERAPEUTIC INTERVENTION SERVICES, INC
Entity Type:Organization
Organization Name:THERAPEUTIC INTERVENTION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-258-4362
Mailing Address - Street 1:2862 LAURIE MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9386
Mailing Address - Country:US
Mailing Address - Phone:252-258-4362
Mailing Address - Fax:
Practice Address - Street 1:1210 PROGRESSIVE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2849
Practice Address - Country:US
Practice Address - Phone:757-410-0382
Practice Address - Fax:757-410-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health