Provider Demographics
NPI:1689828394
Name:EASTERN PSYCHIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:EASTERN PSYCHIATRIC ASSOCIATES, PA
Other - Org Name:B. STEVEN BENTSEN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BIRGER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BENTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-815-0260
Mailing Address - Street 1:PO BOX 7246
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-7246
Mailing Address - Country:US
Mailing Address - Phone:910-815-0260
Mailing Address - Fax:910-202-6462
Practice Address - Street 1:3807 PEACHTREE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6723
Practice Address - Country:US
Practice Address - Phone:910-815-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0296048261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)