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Organization
SUPPORT INCORPORATED
Active
Organization
SUPPORT INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA MEAD (REIMBURSEMENT/CONTRACT MANAGER)
(704) 865-3529
Entity
Organization
Contact information
Practice address
107 N SUMMEY ST, DALLAS, NC 28034-1824
(704) 865-3529
Mailing address
PO BOX 4003, GASTONIA, NC 28054-0041
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/13/2015
Last updated
12/31/2015
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