Provider Demographics
NPI:1891902607
Name:EMOTIONAL RECOVERY AND WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:EMOTIONAL RECOVERY AND WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-474-7530
Mailing Address - Street 1:25 W GUILFORD ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3945
Mailing Address - Country:US
Mailing Address - Phone:336-474-7530
Mailing Address - Fax:336-474-7531
Practice Address - Street 1:25 W GUILFORD ST
Practice Address - Street 2:SUITE 7
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3945
Practice Address - Country:US
Practice Address - Phone:336-474-7530
Practice Address - Fax:336-474-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO24261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC555099OtherVALUOPTIONS
NC6106135Medicaid
NCNJ135OtherBCBSNC
NCNJ135OtherBCBSNC