# MAKING A DIFFERENCE COMMUNITY SUPPORT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912186735
- **Authorized official:** SHANEQUA CORNISE BENTON (MEMBER/ORGANIZER)
- **Authorized official phone:** (252) 475-9829

## Contact information

- **Practice address:** 102 OLD TOM AVE., MANTEO, NC 27954
- **Practice address phone:** (252) 475-9829
- **Mailing address:** PO BOX 7672, KILL DEVIL HILLS, NC 27948-6672
- **Mailing address phone:** (252) 475-9829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | 261QM0850X | NC | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 261QM0855X | NC | — |
| 261QR0400X | Rehabilitation Clinic/Center | 261QR0400X | NC | Yes |

## Other

- **Enumeration date:** 10/29/2007
- **Last updated:** 11/01/2007