Provider Demographics
NPI:1245881366
Name:POSITIVE GENERATION IN CHRIST, INCORPORATED
Entity type:Organization
Organization Name:POSITIVE GENERATION IN CHRIST, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IMMACULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-879-4763
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1634
Mailing Address - Country:US
Mailing Address - Phone:252-641-4522
Mailing Address - Fax:252-641-5461
Practice Address - Street 1:608 GREGG AVE # 102103
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4317
Practice Address - Country:US
Practice Address - Phone:252-641-4522
Practice Address - Fax:252-641-5461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE GENERATION IN CHRIST, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942562541Medicaid
SCGP9424Medicaid