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Organization
SHADOWS COMMUNITY SUPPORT CENTER LLC
Active
Organization
SHADOWS COMMUNITY SUPPORT CENTER LLC
Active
Other names
Gloria Crandell-Nelson
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA CRANDELL-NELSON (CEO)
(252) 795-6662
Entity
Organization
Contact information
Practice address
7356 HWY 64 E ALT, ROBERSONVILLE, NC 27871
(252) 795-6662
Mailing address
7356 HWY 64 E ALT, ROBERSONVILLE, NC 27871
(252) 795-6662
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004230
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950083
—
NC
05
—
6003087
—
NC
Enumeration date
07/21/2008
Last updated
07/21/2008
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