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NPI Code Detail

MEDICARE: SUPPORT INCORPORATED

MEDICARE: SUPPORT INCORPORATED
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
11041C0700XClinical Social Worker
2101YA0400XAddiction (Substance Use Disorder) Counselor
3101YM0800XMental Health Counselor
4101YP2500XProfessional Counselor
5103TC0700XClinical Psychologist
6106H00000XMarriage & Family Therapist
72084P0804XChild & Adolescent Psychiatry Physician
8363A00000XPhysician Assistant
9363LP0808XPsychiatric/Mental Health Nurse Practitioner
10363L00000XNurse Practitioner
11363LF0000XFamily Nurse Practitioner
12103T00000XPsychologist
13251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1871986919
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPPORT INCORPORATED
Provider Business Mailing Address
First Line : PO BOX 4003
Second Line :
City : GASTONIA
State : NC
Zip : 28054-0041
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 107 N SUMMEY ST
Second Line :
City : DALLAS
State : NC
Zip : 28034-1824
Country : US
Telephone Number : 704-865-3529
Fax Number :
Authorized Official
Title or Position : REIMBURSEMENT/CONTRACT MANAGER
Name : LINDA MEAD
Credential :
Telephone Number : 704-865-3529
Provider Enumeration Date : 03/13/2015
Last Update Date : 12/31/2015

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Directions to “SUPPORT INCORPORATED ” Practice Location

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