| NPI | 1720145535 |
|---|---|
| Former Legal Business Name | PORT HUMAN SERVICES |
| Entity Type | Organization |
| Authorized Contact | BRETT BEAVERS Credentialing Manager 919-210-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-05-24 |