Vickie M Persaud

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

605 Thomas Nelson Street,
Colerain, NC 27924-0134

Phone

(125) 264-2534

Fax

(252) 642-5300

NPI assigned

Sep 13, 2017

Reactivated

Feb 26, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• A Fresh Start Southern Support Recovery Services, LLC

  • Adult Mental Health Clinic/Center
  • Colerain, NC
  • NPI 1508728023
  NPD Authorized official
• Inner-Coastal Personal Home Care Services, Inc

  • In Home Supportive Care Agency
  • Ahoskie, NC
  • NPI 1184375743
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1174042907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 134",
            "city": "COLERAIN",
            "state": "NC",
            "postal_code": "279240134",
            "telephone_number": "252-642-5345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 THOMAS NELSON STREET,",
            "city": "COLERAIN",
            "state": "NC",
            "postal_code": "279240134",
            "telephone_number": "125-264-2534",
            "fax_number": "252-642-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSAUD",
        "first_name": "VICKIE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-13",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "deactivation_date": "2019-05-19",
        "reactivation_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitley Arvis Lawrence, FNP-C
• Life Design Services, Inc.
• Moore'S Family Care Home 1
• New Horizons Community Support Services, Inc.
• New Horizons Community Support Services, Inc.
• Tiffany Kathryn Pierce Lassiter, RN
• Roanoke Chowan Community Health Center Inc
• Roanoke Chowan Community Health Center Inc
• Roanoke Chowan Community Health Center Inc
• Robbie Dietz Sawyer, RPH

• All providers in Colerain, NC
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.