NPIMap

Organization Active NPI

Community Support Professionals,LLC

  • Psychiatry Physician
  • Wilmington, NC
National Provider Identifier
1588993786
Registry record updated Dec 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
5912872 Issued in NC
Legal business name
COMMUNITY SUPPORT PROFESSIONALS,LLC
Practice address
1606 Wellington Ave Unit C
Wilmington, NC 28401-7704
Phone
(910) 799-4505
Fax
(910) 799-4345
NPI assigned
Dec 17, 2009
Last updated
Dec 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2009

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

Authorized official

Name
Mr. Martin P Justafort
Title
Operations Manager
Phone
(910) 799-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 5912872 NC Primary

Addresses

Primary practice location

1606 Wellington Ave Unit C
Wilmington, NC 28401-7704

Mailing address

1606 Wellington Ave Unit C
Wilmington, NC 28401-7704
Phone (910) 799-4505

Other identifiers 1

IdentifierTypeStateIssuer
5912872MedicaidNC

Other names 1

  • CSP Physician Svces Other name

National Provider Directory

National Provider Directory
Tax ID family
Community Support Professionalsllc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261008000000",
    "number": "1588993786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 WELLINGTON AVE UNIT C",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017704",
            "telephone_number": "910-799-4505",
            "fax_number": "910-799-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 WELLINGTON AVE UNIT C",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017704",
            "telephone_number": "910-799-4505",
            "fax_number": "910-799-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT PROFESSIONALS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2009-12-17",
        "status": "A",
        "authorized_official_last_name": "JUSTAFORT",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "910-799-4505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "5912872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912872",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CSP Physician Svces",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.