Provider Demographics
NPI:1104570613
Name:NEW LIFE CHRISTIAN FELLOWSHIP OF CURRITUCK
Entity type:Organization
Organization Name:NEW LIFE CHRISTIAN FELLOWSHIP OF CURRITUCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PASTOR/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGEY
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:252-453-2773
Mailing Address - Street 1:4134 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:BARCO
Mailing Address - State:NC
Mailing Address - Zip Code:27917-9510
Mailing Address - Country:US
Mailing Address - Phone:252-453-2773
Mailing Address - Fax:
Practice Address - Street 1:4134 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:BARCO
Practice Address - State:NC
Practice Address - Zip Code:27917-9510
Practice Address - Country:US
Practice Address - Phone:252-453-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty