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General NPI Number Information
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NPI Number | 1043345184
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Entity Type | Organization
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Legal Business Name | MONAE SUPPORTIVE SERVICES
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 323 CLIFTON ST STE 15
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City | GREENVILLE
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State | NC
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Zip | 27858-5053
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Country | US
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Telephone | 252-321-8488
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Fax | 252-321-2209
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Provider Business Mailing Address
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Address Line | 323 CLIFTON ST STE 15
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City | GREENVILLE
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State | NC
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Zip | 27858-5053
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Country | US
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Telephone | 252-321-8488
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Fax | 252-321-2209
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CYNTHIA NMN TYSON
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Credential |
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Telephone | 252-757-2925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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