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General NPI Number Information
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NPI Number | 1649141755
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Entity Type | Organization
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Legal Business Name | COURAGEOUS IMPACT ADVOCACY & SUPPORT
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Dates
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Enumeration Date | 09/13/2025
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 2179 BAYSIDE DR SW
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City | SUPPLY
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State | NC
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Zip | 28462-3977
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Country | US
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Telephone | 910-918-5586
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Fax |
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Provider Business Mailing Address
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Address Line | 2179 BAYSIDE DR SW
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City | SUPPLY
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State | NC
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Zip | 28462-3977
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Country | US
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Telephone | 910-918-5586
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Fax |
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Authorized Official
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Title or Position | CFPS, CEO
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Name | MRS. NYISHA POWELL
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Credential | CFPS
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Telephone | 910-918-5586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 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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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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