| NPI | 1942674999 |
|---|---|
| Former Legal Business Name | PORT HUMAN SERVICES |
| Entity Type | Organization |
| Authorized Contact | BRETT BEAVERS Credentialing Manager 919-210-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2023-05-24 |