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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
175 W FRANKLIN BLVD, GASTONIA, NC 28052-4145
(704) 865-3529
(704) 867-0638
Mailing address
PO BOX 4003, GASTONIA, NC 28054-0041
(704) 865-3529
(704) 867-0638
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
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
MHL-023-078
NC
253J00000X
Foster Care Agency
—
NC
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3410013
—
NC
05
—
3418141
—
NC
05
—
5900737
—
NC
05
—
5900740
—
NC
05
—
5918314
—
NC
05
—
6005063
—
NC
05
—
8300332
—
NC
05
—
8300333
—
NC
05
—
8300340
—
NC
05
—
8303341
—
NC
05
—
8703014
—
NC
Enumeration date
06/17/2010
Last updated
12/30/2015
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