Healthcare Provider Details

I. General information

NPI: 1316241201
Provider Name (Legal Business Name): SOLUTIONS COMMUNITY SUPPORT AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 N MEBANE ST SUITE 101
BURLINGTON NC
27217-3966
US

IV. Provider business mailing address

236 N MEBANE ST SUITE 101
BURLINGTON NC
27217-3966
US

V. Phone/Fax

Practice location:
  • Phone: 336-436-0074
  • Fax: 336-436-0232
Mailing address:
  • Phone: 336-436-0074
  • Fax: 336-436-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES MOIR STRICKLAND JR.
Title or Position: QUALITY MANAGEMENT TRAINING DIRECT
Credential: BA
Phone: 336-436-0074