Healthcare Provider Details

I. General information

NPI: 1427452564
Provider Name (Legal Business Name): FIRST STEP COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239A S FIFTH ST
MEBANE NC
27302-9706
US

IV. Provider business mailing address

1239A S FIFTH ST
MEBANE NC
27302-9706
US

V. Phone/Fax

Practice location:
  • Phone: 336-395-3832
  • Fax: 336-395-3847
Mailing address:
  • Phone: 336-395-3832
  • Fax: 336-395-3847

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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MAHKAL L MATHEWS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 919-480-9793