Healthcare Provider Details

I. General information

NPI: 1699130773
Provider Name (Legal Business Name): APEX SELECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E MAIN ST STE 200
ROCK HILL SC
29730-5371
US

IV. Provider business mailing address

101 S ELM ST STE 125
GREENSBORO NC
27401-2698
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-7018
  • Fax:
Mailing address:
  • Phone: 443-440-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RODNEY BLACKSTOCK
Title or Position: CEO
Credential:
Phone: 443-440-7018