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General NPI Number Information
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NPI Number | 1215792056
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Entity Type | Organization
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Legal Business Name | SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 275 OLD LATHAM RD
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City | DRESDEN
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State | TN
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Zip | 38225-1942
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Country | US
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Telephone | 731-333-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E GROVE RD
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City | GLEASON
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State | TN
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Zip | 38229-7918
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Country | US
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Telephone | 173-363-5334
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATO/ THERAPIST
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Name | GINA LOUISE MCCLURE
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Credential | MA.LCADC
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Telephone | 173-136-3533
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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 |
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