MEDICARE: COMMUNITY CARE SUPPORT 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063302628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE SUPPORT SERVICES INC

Provider Business Mailing Address
First Line	:	517 S NORWOOD ST
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1619
Country	:	US
Telephone Number	:	910-779-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 POST OFFICE RD STE 101
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2738
Country	:	US
Telephone Number	:	910-779-7800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDON L HALL
Credential	:
Telephone Number	:	910-779-7800

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	12/01/2025

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