Organization
MAKING A DIFFERENCE COMMUNITY SUPPORT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ORLANDO SMALL (DESIGNEE)
(919) 931-2225
Entity
Organization
Contact information
Practice address
104 W WATER ST, PLYMOUTH, NC 27962-1306
(252) 793-2823
(252) 793-4139
Mailing address
49 MACKEYS RD, PLYMOUTH, NC 27962-9609
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
103TH0100X
Health Service Psychologist
—
—
Other
Enumeration date
03/24/2010
Last updated
03/24/2010
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