Healthcare Provider Details

I. General information

NPI: 1518754845
Provider Name (Legal Business Name): ASPIRE POLK COUNTY: A CHILD & FAMILY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 N PEAK ST
COLUMBUS NC
28722
US

IV. Provider business mailing address

PO BOX 520
COLUMBUS NC
28722-0520
US

V. Phone/Fax

Practice location:
  • Phone: 980-920-5450
  • Fax:
Mailing address:
  • Phone: 980-920-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY ELIZABETH WILSON
Title or Position: BOARD PRESIDENT
Credential:
Phone: 864-237-4327