Organization
LOUISIANA SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER BENJAMIN HARRIS (OWNER)
(252) 717-5717
Entity
Organization
Contact information
Practice address
1912 BRILEY RD, GREENVILLE, NC 27834-8906
(252) 717-5717
(252) 754-2008
Mailing address
1912 BRILEY RD, GREENVILLE, NC 27834-8906
(252) 717-5717
(252) 754-2008
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/07/2011
Last updated
09/07/2011
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