Healthcare Provider Details

I. General information

NPI: 1851464150
Provider Name (Legal Business Name): NC RECOVERY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NAVAHO DR SUITE 125
RALEIGH NC
27609-7319
US

IV. Provider business mailing address

1100 NAVAHO DR SUITE 125
RALEIGH NC
27609-7319
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-9874
  • Fax:
Mailing address:
  • Phone: 919-431-9874
  • Fax: 919-550-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number779
License Number StateNC

VIII. Authorized Official

Name: CLARA DOWNING BAIN
Title or Position: OWNER
Credential: LCAS
Phone: 919-320-4981