Healthcare Provider Details

I. General information

NPI: 1255216586
Provider Name (Legal Business Name): J & J SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 BAYMONT CT
STANLEY NC
28164-2332
US

IV. Provider business mailing address

1609 BAYMONT CT
STANLEY NC
28164-2332
US

V. Phone/Fax

Practice location:
  • Phone: 919-259-9750
  • Fax:
Mailing address:
  • Phone: 919-259-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACK ELLERBE
Title or Position: OWNER
Credential: MSW, LCASA, LCSWA
Phone: 929-259-9750