Healthcare Provider Details

I. General information

NPI: 1942093893
Provider Name (Legal Business Name): COMMUNITY CARE SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S NORWOOD ST
WALLACE NC
28466-1619
US

IV. Provider business mailing address

517 S NORWOOD ST
WALLACE NC
28466-1619
US

V. Phone/Fax

Practice location:
  • Phone: 910-779-7800
  • Fax:
Mailing address:
  • Phone: 910-779-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRANDON HALL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 910-779-7800