Provider Demographics
NPI:1902413875
Name:YMCA OF SOUTHEASTERN NC
Entity Type:Organization
Organization Name:YMCA OF SOUTHEASTERN NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF COMMUNITY HEALTH PRO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-251-9622
Mailing Address - Street 1:PO BOX 3467
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406
Mailing Address - Country:US
Mailing Address - Phone:910-251-9622
Mailing Address - Fax:844-854-4659
Practice Address - Street 1:2710 MARKET STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-251-8196
Practice Address - Fax:844-854-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty