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Organization
PROFESSIONAL GROUP LIVING, LLC
Active
Organization
PROFESSIONAL GROUP LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NATALKA A LOCK MASSEY (EXECUTIVE DIRECTOR)
(919) 475-5845
Entity
Organization
Contact information
Practice address
1775 GRAHAM AVE, SUITE 104, HENDERSON, NC 27536-5948
(919) 475-5845
Mailing address
1775 GRAHAM AVE, SUITE 104, HENDERSON, NC 27536-5948
(919) 475-5845
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302074
—
NC
Enumeration date
10/11/2007
Last updated
10/11/2007
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