Healthcare Provider Details

I. General information

NPI: 1508710468
Provider Name (Legal Business Name): PRIME CARE SUPPORT SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 BON AIR AVE
DURHAM NC
27704-3301
US

IV. Provider business mailing address

613 BON AIR AVE
DURHAM NC
27704-3301
US

V. Phone/Fax

Practice location:
  • Phone: 919-914-3828
  • Fax:
Mailing address:
  • Phone: 919-914-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAREE JONES
Title or Position: THERAPIST
Credential: LCSW, LCASA
Phone: 919-914-3828