NPIMap

Organization Active NPI

Prosource Therapeutics, LLC

  • Clinical Social Worker
  • Robersonville, NC
National Provider Identifier
1578799664
Registry record updated Jun 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
PROSOURCE THERAPEUTICS, LLC
Practice address
7356 US Highway 64
Robersonville, NC 27871-9073
Phone
(252) 353-7025
Fax
(252) 353-7028
NPI assigned
Jun 3, 2009
Last updated
Jun 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2009

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

Authorized official

Name
Phyllis Smith
Title
Administrator
Phone
(252) 353-7025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

7356 US Highway 64
Robersonville, NC 27871-9073

Mailing address

102 Fox Haven Dr
#A
Greenville, NC 27858-9720
Phone (252) 353-7025

National Provider Directory

National Provider Directory
Tax ID family
Prosource Therapeutics LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7356 US Highway 64
Robersonville, NC 27871
Phone (252) 353-7025

NPI Registry JSON

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1578799664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 FOX HAVEN DR",
            "address_2": "#A",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278589720",
            "telephone_number": "252-353-7025",
            "fax_number": "252-353-7028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7356 US HIGHWAY 64",
            "city": "ROBERSONVILLE",
            "state": "NC",
            "postal_code": "278719073",
            "telephone_number": "252-353-7025",
            "fax_number": "252-353-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSOURCE THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-03",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-353-7025"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Robersonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.