Basic Information
| Provider Information | |||||||||
| NPI: | 1558426007 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN PSYCHIATRIC & BEHAVIORAL SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1704 E ARLINGTON BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278587828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527564899 | ||||||||
| FaxNumber: | 2527565141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1704 E ARLINGTON BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278587828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527564899 | ||||||||
| FaxNumber: | 2527565141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | DUNN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2527564899 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 6005132 | 05 | NC | MEDICAID | 690276L | 05 | NC | MEDICAID | 012MU | 01 | NC | BCBS GROUP NUMBER | OTHER | 89012MU | 05 | NC | MEDICAID | 0276L | 01 | NC | BCBS GROUP NUMBER | OTHER |