Provider Demographics
NPI:1285803668
Name:DEBRA MINOR-SCHORK LLC
Entity type:Organization
Organization Name:DEBRA MINOR-SCHORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MINOR-SCHORK
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN CS
Authorized Official - Phone:252-632-4063
Mailing Address - Street 1:119 MONTPELIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-8909
Mailing Address - Country:US
Mailing Address - Phone:125-263-2406
Mailing Address - Fax:252-482-5713
Practice Address - Street 1:504 EAST ELIZABETH STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4404
Practice Address - Country:US
Practice Address - Phone:252-526-8833
Practice Address - Fax:252-482-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004040Medicaid