Provider Demographics
NPI:1700425501
Name:SURE FOUNDATION BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SURE FOUNDATION BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:BATTS
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:BA,MS,LCAS,CCS,MAC,S
Authorized Official - Phone:252-215-3089
Mailing Address - Street 1:PO BOX 8211
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8211
Mailing Address - Country:US
Mailing Address - Phone:252-215-3089
Mailing Address - Fax:
Practice Address - Street 1:3219 LANDMARK ST STE 3A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7688
Practice Address - Country:US
Practice Address - Phone:252-215-3089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty