Provider Demographics
NPI:1770353914
Name:DREAM BIG 1 CONTINUUM OF CARE
Entity type:Organization
Organization Name:DREAM BIG 1 CONTINUUM OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, JD
Authorized Official - Phone:252-470-7236
Mailing Address - Street 1:2105 PRESBYTERIAN LN # 1002
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-2265
Mailing Address - Country:US
Mailing Address - Phone:252-470-7236
Mailing Address - Fax:
Practice Address - Street 1:100 E PENN SQ STE 400
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3310
Practice Address - Country:US
Practice Address - Phone:267-857-9734
Practice Address - Fax:909-443-9497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DREAM BIG 1 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039891100001Medicaid