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General NPI Number Information
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NPI Number | 1851130934
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Entity Type | Organization
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Legal Business Name | MEANINGFUL CONNECTIONS PROGRAM LLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 216 N BICKETT BLVD STE 7
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City | LOUISBURG
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State | NC
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Zip | 27549-2473
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Country | US
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Telephone | 252-213-0168
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Fax |
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Provider Business Mailing Address
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Address Line | 216 N BICKETT BLVD STE 7
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City | LOUISBURG
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State | NC
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Zip | 27549-2473
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Country | US
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Telephone | 252-213-0168
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GLORIA DENISE KEARNEY
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Credential |
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Telephone | 225-213-0168
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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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