Provider Demographics
NPI:1952900615
Name:EASTERN TRAUMA & RECOVERY COUNSELING SERVICE
Entity Type:Organization
Organization Name:EASTERN TRAUMA & RECOVERY COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:HORTON
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS-A; CCTP; CFTP
Authorized Official - Phone:252-903-5594
Mailing Address - Street 1:11814 US 64A
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-9637
Mailing Address - Country:US
Mailing Address - Phone:252-903-5594
Mailing Address - Fax:252-303-0616
Practice Address - Street 1:11814 US 64A
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882-9637
Practice Address - Country:US
Practice Address - Phone:252-903-5594
Practice Address - Fax:252-303-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty