Provider Demographics
NPI:1245468669
Name:NORTHEASTERNECONOMICEMPOWERMENTCORPORATION
Entity type:Organization
Organization Name:NORTHEASTERNECONOMICEMPOWERMENTCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SYLVESTER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BSW,MS
Authorized Official - Phone:252-308-7054
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0355
Mailing Address - Country:US
Mailing Address - Phone:252-396-0300
Mailing Address - Fax:
Practice Address - Street 1:200 S WYNN ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1816
Practice Address - Country:US
Practice Address - Phone:252-396-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty