Peer Support NC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PEER SUPPORT NC

Practice address

1712 S Lafayette St
Shelby, NC 28152-7151

Phone

(704) 492-1533

NPI assigned

Jun 5, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Keon Devonte Breeden, LSCWA

Title

Director

Phone

(704) 386-8651

Specialties & licenses 1

Addresses

Other names 1

• Peer Support NC Doing business as

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cedric Dean, CPP

  • Prevention Professional
  • Charlotte, NC
  • NPI 1114647013
  NPD
• Marian Denise Edwards

  • Home Modifications Contractor
  • Shelby, NC
  • NPI 1356063622
  NPD

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1346934288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5502 MCCHESNEY DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282697188",
            "telephone_number": "704-492-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 S LAFAYETTE ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281527151",
            "telephone_number": "704-492-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEER SUPPORT NC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "BREEDEN",
        "authorized_official_first_name": "KEON",
        "authorized_official_middle_name": "DEVONTE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-386-8651",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LSCWA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.peersupportnc.com",
            "affiliation": "N",
            "endpointDescription": "Behavioral Health",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Provide preventative education and counsel to at-risk populations to protect their health, safety, and welfare.",
            "address_1": "1712 S Lafayette St",
            "city": "Shelby",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281527151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Peer Support NC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Shelby, NC
• Providers in Shelby, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; 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.