Healthcare Provider Details

I. General information

NPI: 1134443351
Provider Name (Legal Business Name): AGAPE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 CIRCLE DR
MONROE NC
28112-3800
US

IV. Provider business mailing address

806 CIRCLE DR PO BOX 3319
MONROE NC
28112-3800
US

V. Phone/Fax

Practice location:
  • Phone: 704-225-0584
  • Fax: 704-225-1479
Mailing address:
  • Phone: 704-225-0584
  • Fax: 704-225-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5212
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5901922
License Number StateNC

VIII. Authorized Official

Name: MR. WILLIAM JEFFERY MASSEY
Title or Position: CEO
Credential:
Phone: 704-225-0584