Basic Information
| Provider Information | |||||||||
| NPI: | 1275965113 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAYMARK RECOVERY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 BEECH ST | ||||||||
| Address2: | |||||||||
| City: | NEWLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286579670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287335889 | ||||||||
| FaxNumber: | 8287338743 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 BEECH ST | ||||||||
| Address2: | |||||||||
| City: | NEWLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286579670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287335889 | ||||||||
| FaxNumber: | 8287338743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2013 | ||||||||
| LastUpdateDate: | 08/02/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BURKS | ||||||||
| AuthorizedOfficialFirstName: | JULIANN | ||||||||
| AuthorizedOfficialMiddleName: | RUTH | ||||||||
| AuthorizedOfficialTitleorPosition: | IIH TEAM LEAD | ||||||||
| AuthorizedOfficialTelephone: | 8287335889 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMFTA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 8082A | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.