Healthcare Provider Details

I. General information

NPI: 1861318735
Provider Name (Legal Business Name): TOUCHED BY AN ANGEL SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FERNWOOD CIR
LUMBERTON NC
28360-8802
US

IV. Provider business mailing address

202 FERNWOOD CIR
LUMBERTON NC
28360-8802
US

V. Phone/Fax

Practice location:
  • Phone: 910-740-6266
  • Fax: 910-740-6266
Mailing address:
  • Phone: 910-740-6266
  • Fax: 910-740-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JAVORIS MONTE GORDON
Title or Position: OWNER
Credential:
Phone: 910-740-6266