Provider Demographics
NPI:1740415637
Name:EARLY ADOLESCENT INTERVENTION SERVICES
Entity Type:Organization
Organization Name:EARLY ADOLESCENT INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMELYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-258-3000
Mailing Address - Street 1:3175 BOARDWALK LN
Mailing Address - Street 2:APT. 6
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6196
Mailing Address - Country:US
Mailing Address - Phone:252-258-3000
Mailing Address - Fax:
Practice Address - Street 1:3175 BOARDWALK LN
Practice Address - Street 2:APT. 6
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6196
Practice Address - Country:US
Practice Address - Phone:252-258-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health