Provider Demographics
NPI:1720210438
Name:PERKINS, ELRETHA J
Entity Type:Individual
Prefix:DR
First Name:ELRETHA
Middle Name:J
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 TOMLIN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27048-7667
Mailing Address - Country:US
Mailing Address - Phone:336-627-8057
Mailing Address - Fax:336-612-2244
Practice Address - Street 1:135 TOMLIN CREEK LN
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048-7667
Practice Address - Country:US
Practice Address - Phone:336-627-8057
Practice Address - Fax:336-612-2244
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-079-101101YM0800X, 103K00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst