Krystal'S House, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

KRYSTAL'S HOUSE, LLC

Practice address

208 N Greene St
Snow Hill, NC 28580-1410

Phone

(252) 747-2988

Fax

(252) 747-4330

NPI assigned

Apr 20, 2009

Organization subpart

No

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

Authorized official

Name

Carolyn Hodges Bryant

Title

Ceo

Phone

(252) 747-2988

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240185600000",
    "number": "1265675375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N GREENE ST",
            "city": "SNOW HILL",
            "state": "NC",
            "postal_code": "285801410",
            "telephone_number": "252-747-2988",
            "fax_number": "252-747-4330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N GREENE ST",
            "city": "SNOW HILL",
            "state": "NC",
            "postal_code": "285801410",
            "telephone_number": "252-747-2988",
            "fax_number": "252-747-4330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRYSTAL'S HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2009-04-20",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "HODGES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-747-2988"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; 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.