Provider Demographics
NPI:1023505112
Name:EASTERN COMMUNITY CARE FOUNDATION
Entity type:Organization
Organization Name:EASTERN COMMUNITY CARE FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRE
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPCA, LCASA
Authorized Official - Phone:833-781-6474
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NC
Mailing Address - Zip Code:27806-0441
Mailing Address - Country:US
Mailing Address - Phone:252-495-0727
Mailing Address - Fax:
Practice Address - Street 1:417 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4827
Practice Address - Country:US
Practice Address - Phone:833-781-6474
Practice Address - Fax:252-362-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23429101YA0400X
NCA13578101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty