NPIMap

Making a Difference Community Support Inc

Organization Active NPI Clinical Child & Adolescent Psychologist · Plymouth, NC

NPI 1598089203 · NPPES record last updated Mar 24, 2010

Key facts

NPI
1598089203
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Child & Adolescent Psychologist 103TC2200X
Legal business name
MAKING A DIFFERENCE COMMUNITY SUPPORT INC
Practice address
104 W Water St
Plymouth, NC 27962-1306
Phone
(252) 793-2823
Fax
(252) 793-4139
NPI assigned
Mar 24, 2010
Organization subpart
No

Authorized official

Name
Mr. Orlando Small
Title
Designee
Phone
(919) 931-2225

Corporate family (same tax ID) 2

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

National Provider Directory

Tax ID family
Making a Difference Community Support Inc (3 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP		 101YM0800X
Clinical Child & Adolescent Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP		 103TC2200X Yes
Health Service Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP		 103TH0100X

Addresses

Primary practice location

104 W Water St
Plymouth, NC 27962-1306

Mailing address

49 Mackeys Rd
Plymouth, NC 27962-9609

Other providers in Plymouth, NC

All providers in Plymouth, NC · Clinical Child & Adolescent Psychologist in North Carolina

Sources for this page

Verify at the official NPI Registry.