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Organization
PELHAM SUPPORTIVE SERVICES
Active
Organization
PELHAM SUPPORTIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILDRED C WILSON (PRESIDENT)
(910) 630-6757
Entity
Organization
Contact information
Practice address
315 A WEST BROAD STREET, ST PAULS, NC 28384-1535
(910) 865-3358
(910) 865-3358
Mailing address
949 COUNTRY CLUB DR, FAYETTEVILLE, NC 28301-2907
(910) 630-6757
(910) 884-9804
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MNL-078-284
NC
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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