Provider Demographics
NPI:1972094902
Name:EAGLE VISION EMPOWERMENT SERVICES
Entity Type:Organization
Organization Name:EAGLE VISION EMPOWERMENT SERVICES
Other - Org Name:EAGLE VISION BEHAVIOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTENAY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-892-6614
Mailing Address - Street 1:1101 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6622
Mailing Address - Country:US
Mailing Address - Phone:919-892-6614
Mailing Address - Fax:919-289-1490
Practice Address - Street 1:1101 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6622
Practice Address - Country:US
Practice Address - Phone:904-853-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty