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Organization
SUPPORT INCORPORATED
Active
Organization
SUPPORT INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSH MARTIN (EXECUTIVE DIRECTOR)
(704) 865-3529
Entity
Organization
Contact information
Practice address
708 S CHESTNUT ST, GASTONIA, NC 28054-4548
(704) 865-3525
(704) 865-3520
Mailing address
PO BOX 4003, GASTONIA, NC 28054-0041
(704) 865-3525
(704) 865-3520
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
MHL-036-292
NC
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016V4
BCBS
NC
05
—
5918314
—
NC
05
—
6005063
—
NC
05
—
8303341
—
NC
Enumeration date
04/18/2011
Last updated
12/30/2015
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