Southern Support
Community/Behavioral Health in Gaston, NC. Organization (NPI-2).
NPI number1982143848
StatusActive
Last updated in NPPESFeb 13, 2017
Details
- NPI
- 1982143848
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Support
- Organization subpart
- No
- Enumeration date
- Feb 13, 2017
- Last updated
- Feb 13, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
480 River RdGaston, NC 27832-9079
Phone 252-676-1750
Mailing address
480 River RdGaston, NC 27832-9079
Phone 252-676-1750
Authorized official
Jacqueline Harris Dickens
Owner
2526761750
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