Basic Information
| Provider Information | |||||||||
| NPI: | 1144426651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAYNE INITIATIVE FOR SCHOOL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 LIONEL ST | ||||||||
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| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275302931 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3761 US HWY 117 SOUTH | ||||||||
| Address2: | |||||||||
| City: | DUDLEY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197519120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BATTS | ||||||||
| AuthorizedOfficialFirstName: | KATIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 9197519120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 208000000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.