MEDICARE: A STEP ABOVE THERAPEUTIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053578104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A STEP ABOVE THERAPEUTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	200 VALENCIA DR
Second Line	:	SUITE 127
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6311
Country	:	US
Telephone Number	:	910-938-1300
Fax Number	:	910-938-2900

Provider Business Practice Location Address
First Line	:	200 VALENCIA DR
Second Line	:	SUITE 127
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6311
Country	:	US
Telephone Number	:	910-938-1300
Fax Number	:	910-938-2900

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CHARMAINE J DOWDELL
Credential	:	B.S., QP
Telephone Number	:	910-938-1300

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/20/2008

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