Organization
LIFE SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN MCDANIEL (BUSINESS OPERATIONS MANAGER)
(910) 491-9848
Entity
Organization
Contact information
Practice address
202 MAIN STREET, PEMBROKE, NC 28372
(919) 798-0967
Mailing address
PO BOX 2053, GARNER, NC 27529-2053
(919) 798-0967
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
P006527
NC
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
03/29/2018
Last updated
01/24/2019
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