Provider Demographics
NPI:1588168462
Name:PITT COUNTY COMMUNITY COLLABORATIVE ON MENTAL HEALTH AND SUBSTANCE ABU
Entity type:Organization
Organization Name:PITT COUNTY COMMUNITY COLLABORATIVE ON MENTAL HEALTH AND SUBSTANCE ABU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:LIVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSL
Authorized Official - Phone:252-368-6472
Mailing Address - Street 1:PO BOX 2482
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-0482
Mailing Address - Country:US
Mailing Address - Phone:252-368-6472
Mailing Address - Fax:
Practice Address - Street 1:1913 TURNBURY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6168
Practice Address - Country:US
Practice Address - Phone:252-368-6472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable