Organization
COMMUNITY SUPPORT PROFESSIONALS
Active
Other names
SAIOP At CSP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES CREECH (C.E.O.)
(910) 799-4505
Entity
Organization
Contact information
Practice address
1924 SOUTH 16TH STREET, WILMINGTON, NC 28401-7704
(910) 799-4505
(910) 799-4345
Mailing address
1606 WELLINGTON AVE UNIT C, WILMINGTON, NC 28401-7704
(910) 799-4505
(910) 799-4345
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
8300728
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL065218
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300728
—
NC
Enumeration date
09/17/2010
Last updated
09/17/2010
Update your record
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