Provider Demographics
NPI:1952638900
Name:PROFESSIONAL BUSINESS GROUP, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL BUSINESS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-355-0006
Mailing Address - Street 1:400 W 5TH ST
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-1910
Mailing Address - Country:US
Mailing Address - Phone:252-355-0006
Mailing Address - Fax:252-752-6379
Practice Address - Street 1:400 W 5TH ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1910
Practice Address - Country:US
Practice Address - Phone:252-355-0006
Practice Address - Fax:252-752-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty