NPIMap

Organization Active NPI

Alpha Community Support Service LLC

  • Prescribing (Medical) Psychologist
  • Rockingham, NC
National Provider Identifier
1518282201
Registry record updated Apr 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
33577 Issued in NC
Legal business name
ALPHA COMMUNITY SUPPORT SERVICE LLC
Practice address
114 S Hancock St
Rockingham, NC 28379-3630
Phone
(910) 410-0459
Fax
(910) 410-0653
NPI assigned
Apr 6, 2010
Organization subpart
Yes
Parent organization
ALPHA COMMUNITY SUPPORT SERVICE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2010

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

Authorized official

Name
Ms. Michelle Yvette Ellerbe, MA, QP
Title
Owner
Phone
(910) 410-0459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TP0016X 33577 NC Primary

Addresses

Primary practice location

114 S Hancock St
Rockingham, NC 28379-3630

Mailing address

114 S Hancock St
Rockingham, NC 28379-3630
Phone (910) 410-0459

Other identifiers 2

IdentifierTypeStateIssuer
6006930MedicaidNC
8302367MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Alpha Community Support Services LLC3 organizations share this tax ID, including this one
Part of
Alpha Community Support Services LLC

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": "1270512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270512000000",
    "number": "1518282201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 S HANCOCK ST",
            "city": "ROCKINGHAM",
            "state": "NC",
            "postal_code": "283793630",
            "telephone_number": "910-410-0459",
            "fax_number": "910-410-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 S HANCOCK ST",
            "city": "ROCKINGHAM",
            "state": "NC",
            "postal_code": "283793630",
            "telephone_number": "910-410-0459",
            "fax_number": "910-410-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA COMMUNITY SUPPORT SERVICE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALPHA COMMUNITY SUPPORT SERVICE LLC",
        "enumeration_date": "2010-04-06",
        "last_updated": "2010-04-06",
        "status": "A",
        "authorized_official_last_name": "ELLERBE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "YVETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-410-0459",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, QP"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NC",
            "license": "33577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006930",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302367",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockingham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2010; 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.