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General NPI Number Information
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NPI Number | 1235429838
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Entity Type | Organization
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Legal Business Name | E SQUARED COMMUNITY SERVICES, LLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 101 INDUSTRIAL DR SUITE 200
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City | LOUISBURG
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State | NC
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Zip | 27549-2307
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Country | US
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Telephone | 919-340-1677
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Fax | 919-340-1678
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Provider Business Mailing Address
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Address Line | 5022 ISABELLA CANNON DR
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City | RALEIGH
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State | NC
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Zip | 27612-4804
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Country | US
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Telephone | 919-218-7161
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Fax | 919-327-6813
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EMILY LEAK
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Credential |
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Telephone | 919-218-7161
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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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