Organization
A-1 COMMUNITY SUPPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYLON VONDWELL WHITLEY (DIRECTOR)
(919) 649-4757
Entity
Organization
Contact information
Practice address
523 S CHESTNUT ST, HENDERSON, NC 27536-4102
(252) 433-0255
(252) 436-6575
Mailing address
523 S CHESTNUT ST, HENDERSON, NC 27536-4102
(252) 433-0255
(252) 436-6575
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006444
—
NC
Enumeration date
12/10/2007
Last updated
01/22/2009
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