Provider Demographics
NPI:1184068785
Name:ARTIS, DWAN L
Entity type:Individual
Prefix:MR
First Name:DWAN
Middle Name:L
Last Name:ARTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 CAMERON LANGSTON RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-7232
Mailing Address - Country:US
Mailing Address - Phone:252-917-4602
Mailing Address - Fax:
Practice Address - Street 1:1832 CAMERON LANGSTON RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-7232
Practice Address - Country:US
Practice Address - Phone:252-917-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health