Organization
PROFESSIONAL GROUP LIVING,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LLEWELLYN HICKS MSW (OWNER)
(910) 592-2338
Entity
Organization
Contact information
Practice address
4084 BARRETT DR, RALEIGH, NC 27609-6604
(919) 785-9660
Mailing address
715 SOUTHWEST BLVD, B, CLINTON, NC 28328-4636
(919) 592-2338
(910) 592-5508
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL082075
NC
Other
Enumeration date
02/20/2009
Last updated
02/20/2009
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