Healthcare Provider Details

I. General information

NPI: 1326779737
Provider Name (Legal Business Name): SECURE DIRECTION NC, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 SPLICEWOOD DR SW
CONCORD NC
28027-6431
US

IV. Provider business mailing address

355 SPLICEWOOD DR SW
CONCORD NC
28027-6431
US

V. Phone/Fax

Practice location:
  • Phone: 980-284-1639
  • Fax:
Mailing address:
  • Phone: 980-284-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY SCOTT PHILLIPS
Title or Position: MANAGER
Credential: MBA, QP
Phone: 980-284-1639