Healthcare Provider Details

I. General information

NPI: 1740411958
Provider Name (Legal Business Name): A NEW START SUPPORT SERVICES II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11373 US BUSINESS 70 HWY WEST
CLAYTON NC
27520-2208
US

IV. Provider business mailing address

11373 US BUSINESS 70 HWY WEST
CLAYTON NC
27520-2208
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-0669
  • Fax: 919-359-2171
Mailing address:
  • Phone: 919-359-0669
  • Fax: 919-359-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number989
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2010-01241
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. ARLINDA KAY RODRIQUEZ
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: B.A.
Phone: 919-359-0669