Organization
SUPERIOR LIVING,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALARIE ANDERSON (DIRECTOR)
(252) 281-1088
Entity
Organization
Contact information
Practice address
3709 COLUMBIA AVE NW, WILSON, NC 27896-1604
(252) 281-1088
Mailing address
3709 COLUMBIA AVE NW, WILSON, NC 27896-1604
(252) 281-1088
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
MHL098141
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MHL098141
—
NC
Enumeration date
02/02/2010
Last updated
12/16/2011
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