NPIMap

Organization Active NPI

A-1 Community Support LLC

  • Clinical Social Worker
  • Henderson, NC
National Provider Identifier
1487837787
Registry record updated Jan 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
A-1 COMMUNITY SUPPORT LLC
Practice address
523 S Chestnut St
Henderson, NC 27536-4102
Phone
(252) 433-0255
Fax
(252) 436-6575
NPI assigned
Dec 10, 2007
Last updated
Jan 22, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2009

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

Authorized official

Name
Mr. Dwaylon Vondwell Whitley
Title
Director
Phone
(919) 649-4757

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 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
6006444MedicaidNC

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.

Locations

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

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": "1232582400000",
    "number": "1487837787",
    "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": "252-436-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A-1 COMMUNITY SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "WHITLEY",
        "authorized_official_first_name": "DWAYLON",
        "authorized_official_middle_name": "VONDWELL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-649-4757",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006444",
            "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 Jan 22, 2009; 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.