Healthcare Provider Details

I. General information

NPI: 1164384087
Provider Name (Legal Business Name): UNLIMITED SUPPORTS & CONSULTING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 MALLISON WAY
MC LEANSVILLE NC
27301-9004
US

IV. Provider business mailing address

5103 MALLISON WAY
MC LEANSVILLE NC
27301-9004
US

V. Phone/Fax

Practice location:
  • Phone: 336-303-6922
  • Fax: 336-303-6922
Mailing address:
  • Phone: 336-303-6922
  • Fax: 336-303-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYA CELESTE TATE
Title or Position: OWNER
Credential:
Phone: 336-303-6922