NPIMap

Organization Active NPI

A-1 Community Support LLC

  • Psychiatry Physician
  • Henderson, NC
National Provider Identifier
1104009406
Registry record updated Nov 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
A-1 COMMUNITY SUPPORT LLC
Practice address
523 S Chestnut St
Henderson, NC 27536-4102
Phone
(252) 433-0255
Fax
(866) 583-9593
NPI assigned
Dec 10, 2007
Last updated
Nov 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Crystal Denee' Bush, MSW, PLCSW
Title
Director
Phone
(252) 915-4755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

523 S Chestnut St
Henderson, NC 27536-4102

Mailing address

523 S Chestnut St
Henderson, NC 27536-4102
Phone (252) 433-0255

Other identifiers 1

IdentifierTypeStateIssuer
5950172MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
A-1 Community Support LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226620800000",
    "number": "1104009406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 S CHESTNUT ST",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364102",
            "telephone_number": "252-433-0255",
            "fax_number": "252-436-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 S CHESTNUT ST",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364102",
            "telephone_number": "252-433-0255",
            "fax_number": "866-583-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A-1 COMMUNITY SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2008-11-14",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "DENEE'",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "252-915-4755",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, PLCSW"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950172",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.