Organization
COMMUNITY INNOVATIONS, INC
Active
Parent organization
COMMUNITY INNOVATIONS, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY INNOVATIONS, INC
Authorized official
TALESHA ROLLOCK (PROVIDER ENROLLMENT SPECIALIST)
(919) 256-0824
Entity
Organization
Contact information
Practice address
801 WILSON ST, WHITEVILLE, NC 28472-4713
(910) 642-5697
Mailing address
3210 FAIRHILL DR, RALEIGH, NC 27612-3215
(919) 256-0824
(919) 256-0833
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
NC
1041C0700X
Clinical Social Worker
—
NC
Other
Enumeration date
03/26/2008
Last updated
12/17/2008
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