Provider Demographics
NPI:1679042683
Name:GREAT PLACE TO START BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GREAT PLACE TO START BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:LASHALL
Authorized Official - Last Name:COURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:252-349-2154
Mailing Address - Street 1:1425 S GLENBURNIE RD STE 3B
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2610
Mailing Address - Country:US
Mailing Address - Phone:252-349-2154
Mailing Address - Fax:
Practice Address - Street 1:1425 S GLENBURNIE RD STE 3B
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-349-2154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty