=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922311554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | .COMMUNITY COUNSELING SERVICES, PC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2010
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 DURHAM RD
-----------------------------------------------------
City | ROXBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27573-5607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-512-0702
-----------------------------------------------------
Fax | 336-330-0703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 FIRE TOWER DR
-----------------------------------------------------
City | ROUGEMONT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27572-6816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-512-0702
-----------------------------------------------------
Fax | 336-330-0702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SARAH M TAYLOR
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 336-512-0702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------