Provider Demographics
NPI:1952538944
Name:EARLY ADOLESCENT INTERVENTIONS SERVICES, INC.
Entity type:Organization
Organization Name:EARLY ADOLESCENT INTERVENTIONS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMELYA
Authorized Official - Middle Name:ENGLAND
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QP
Authorized Official - Phone:252-724-2319
Mailing Address - Street 1:101 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-1384
Mailing Address - Country:US
Mailing Address - Phone:252-724-2319
Mailing Address - Fax:
Practice Address - Street 1:101 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882-1384
Practice Address - Country:US
Practice Address - Phone:252-724-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health