Healthcare Provider Details

I. General information

NPI: 1154769305
Provider Name (Legal Business Name): SOLUTIONS COMMUNITY SUPPORT AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WALL ST
YANCEYVILLE NC
27379-9382
US

IV. Provider business mailing address

236 N MEBANE ST SUITE 101
BURLINGTON NC
27217-3966
US

V. Phone/Fax

Practice location:
  • Phone: 336-436-0074
  • Fax:
Mailing address:
  • Phone: 336-436-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES MOIR STRICKLAND JR.
Title or Position: QMTD
Credential:
Phone: 336-436-0074