Organization
ADVANCED COMMUNITY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY PENNY (EXECUTIVE DIRECTOR)
(704) 241-1643
Entity
Organization
Contact information
Practice address
4700 FARM POND LN, CHARLOTTE, NC 28212-8500
(704) 241-1643
Mailing address
3984 LANDMARK DR, DOUGLASVILLE, GA 30135-1254
(704) 241-1643
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
NC
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NC
261QM0850X
Adult Mental Health Clinic/Center
—
NC
Other
Enumeration date
02/07/2018
Last updated
04/20/2018
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