Provider Demographics
NPI:1659798403
Name:EMMAUS PURITAN APOSTOLIC BAPTIST
Entity Type:Organization
Organization Name:EMMAUS PURITAN APOSTOLIC BAPTIST
Other - Org Name:EMMAUS CORP. COUNSELING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISORY CHAPLAIN/COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LENT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CARR
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, STH, CED
Authorized Official - Phone:919-417-6768
Mailing Address - Street 1:125 W BELLE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4503
Mailing Address - Country:US
Mailing Address - Phone:919-417-6768
Mailing Address - Fax:252-430-3738
Practice Address - Street 1:125 W BELLE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4503
Practice Address - Country:US
Practice Address - Phone:919-417-6768
Practice Address - Fax:252-430-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health