Prosource Therapeutics LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2971 Issued in NC

Legal business name

PROSOURCE THERAPEUTICS LLC

Practice address

102 Fox Haven Dr
Suite a
Greenville, NC 27858-7100

Phone

(252) 353-7025

Fax

(252) 353-7028

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Phyllis Saunders Smith

Title

Administrator

Phone

(252) 353-7025

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1992758429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 FOX HAVEN DR",
            "address_2": "SUITE A",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278587100",
            "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": "102 FOX HAVEN DR",
            "address_2": "SUITE A",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278587100",
            "telephone_number": "252-353-7025",
            "fax_number": "252-353-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSOURCE THERAPEUTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "SAUNDERS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-353-7025",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "2971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BLUE CROSS BLUE SHIELD",
            "identifier": "017PN",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005734",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Greenville, NC
• Providers in Greenville, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.