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General NPI Number Information
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NPI Number | 1104314384
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Entity Type | Organization
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Legal Business Name | SUPPORTING HEALTH SERVICES SOLUTION
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 1900 S WASHINGTON AVE
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City | MARSHALL
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State | TX
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Zip | 75670-6843
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Country | US
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Telephone | 346-290-5508
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 LOGAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-2316
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Country | US
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Telephone | 318-573-3942
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES MAXIE JR.
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Credential | MA, QMHP-CS,
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Telephone | 318-573-3942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | TX
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Taxonomy #3
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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 | TX
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