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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
LLEWELLYN HICKS MSW (DIRECTOR)
(919) 475-6124
Entity
Organization
Contact information
Practice address
715 SOUTHWEST BLVD., B, CLINTON, NC 28328-4829
(919) 592-2338
(919) 592-5508
Mailing address
510 SIMMONS ST, DURHAM, NC 27701-4334
(919) 688-0818
(919) 688-0918
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
8109498
NC
251S00000X
Community/Behavioral Health Agency
Primary
8109498
NC
Other
Enumeration date
03/13/2009
Last updated
03/13/2009
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