Eagle Vision Empowerment Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW14380 Issued in FL

Legal business name

EAGLE VISION EMPOWERMENT SERVICES

Practice address

1101 S Andrews Ave
Goldsboro, NC 27530-6622

Phone

(904) 853-7737

NPI assigned

May 25, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Courtenay Y Hall, LCSWNPI 1194150136

Title

Therapist

Phone

(919) 892-6614

Specialties & licenses 1

Addresses

Other names 1

• Eagle Vision Behavior Health Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Courtenay Hall, LCSW

  • Clinical Social Worker
  • Goldsboro, NC
  • NPI 1194150136
  NPD Authorized official

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572912000000",
    "number": "1972094902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 S ANDREWS AVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275306622",
            "telephone_number": "919-892-6614",
            "fax_number": "919-289-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 S ANDREWS AVE",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275306622",
            "telephone_number": "904-853-7737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9550 Regency Square Blvd Ste 706",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322258116",
            "country_code": "US",
            "telephone_number": "904-853-7737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAGLE VISION EMPOWERMENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2019-11-05",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "COURTENAY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "919-892-6614",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW14380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Vision Behavior Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.