Provider Demographics
NPI:1750571097
Name:PROGRAM RESOURCE INSTITUTE, INC
Entity type:Organization
Organization Name:PROGRAM RESOURCE INSTITUTE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RIFE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:910-814-0394
Mailing Address - Street 1:P.O. BOX 747
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-7854
Mailing Address - Country:US
Mailing Address - Phone:910-814-0394
Mailing Address - Fax:910-814-1453
Practice Address - Street 1:133 W. CORNELIUS HARNETT BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-7854
Practice Address - Country:US
Practice Address - Phone:910-814-0394
Practice Address - Fax:910-814-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-043-002101Y00000X, 101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty