Provider Demographics
NPI:1700174265
Name:ROBERSONVILLE PSYCHOSOCIAL REHABILITATION, LLC
Entity Type:Organization
Organization Name:ROBERSONVILLE PSYCHOSOCIAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW LCAS CSI
Authorized Official - Phone:252-756-5654
Mailing Address - Street 1:702 CROMWELL DR STE G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5436
Mailing Address - Country:US
Mailing Address - Phone:252-745-5654
Mailing Address - Fax:252-558-0655
Practice Address - Street 1:110 E RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ROBERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27871-0258
Practice Address - Country:US
Practice Address - Phone:252-795-3311
Practice Address - Fax:252-795-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL085047251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health