Organization
COMMUNITY SUPPORT PROFESSIONALS,LLC
Active
Other names
CSP Diagnostic Assessment
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN P. JUSTAFORT (OPERATIONS MANAGER)
(910) 799-4505
Entity
Organization
Contact information
Practice address
1606 WELLINGTON AVE UNIT C, WILMINGTON, NC 28401-7704
(910) 799-4505
(910) 799-4345
Mailing address
1606 WELLINGTON AVE UNIT C, WILMINGTON, NC 28401-7704
(910) 799-4505
(910) 799-4345
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
8300728G
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300728G
—
NC
Enumeration date
12/07/2009
Last updated
12/07/2009
Update your record
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