Organization
AUTISM TRANSITIONAL LIVING PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NA DANIELS LCSW (DIRECTOR)
(919) 300-9338
Entity
Organization
Contact information
Practice address
1217 CROSS CREEK CIR APT E1, GREENVILLE, NC 27834-5088
(919) 300-9338
Mailing address
1217 CROSS CREEK CIR APT E1, GREENVILLE, NC 27834-5088
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
11/16/2022
Last updated
11/17/2022
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