Healthcare Provider Details

I. General information

NPI: 1992265763
Provider Name (Legal Business Name): BETTER COMMUNITY COMMUNITY COUNSELING HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HARRIS ST
JACKSON MS
39202-3471
US

IV. Provider business mailing address

203 WINDRUSH LN
DURHAM NC
27703-9457
US

V. Phone/Fax

Practice location:
  • Phone: 336-508-6582
  • Fax:
Mailing address:
  • Phone: 336-508-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALFONSO ALLEN
Title or Position: OWNER
Credential:
Phone: 336-508-6582