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General NPI Number Information
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NPI Number | 1598089203
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Entity Type | Organization
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Legal Business Name | MAKING A DIFFERENCE COMMUNITY SUPPORT INC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 104 W WATER ST
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City | PLYMOUTH
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State | NC
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Zip | 27962-1306
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Country | US
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Telephone | 252-793-2823
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Fax | 252-793-4139
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Provider Business Mailing Address
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Address Line | 49 MACKEYS RD
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City | PLYMOUTH
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State | NC
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Zip | 27962-9609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DESIGNEE
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Name | MR. ORLANDO SMALL
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Credential |
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Telephone | 919-931-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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