Organization
SELF DETERMINATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNE JEFFRIES BC-HSP (OWNER)
(980) 297-8964
Entity
Organization
Contact information
Practice address
423 MILLSAP RD, SHELBY, NC 28150
(704) 600-6092
Mailing address
423 MILLSAP RD, SHELBY, NC 28150-9634
(704) 600-6092
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
623-203
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H2020
—
NC
Enumeration date
06/29/2016
Last updated
12/08/2022
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