Agape Recovery Center
Organization Active NPI Clinical Social Worker · Henderson, NC
NPI 1669833760 · NPPES record last updated Dec 18, 2023
Key facts
- NPI
- 1669833760
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C009632 (NC)
- Legal business name
- AGAPE RECOVERY CENTER
- Practice address
- 8338 NC Highway 39 S
Henderson, NC 27537-7132 - Phone
- (919) 538-5459
- NPI assigned
- Mar 16, 2016
- Organization subpart
- No
Authorized official
- Name
- Evangeline D. Matthews, LCSW
- Title
- Owner/Therapist
- Phone
- (919) 538-5459
Practitioners 1
-
Evangeline D. Matthews, LCSWA, LCASA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180216001821 | NC | Part B Supplier - Clinic/Group Practice | 4789944570 |
Receives reassigned benefits from 1 practitioner Practice locations: Henderson, NC |
National Provider Directory
Locations
1100 Logger Ct
Ste A100
Raleigh, NC 27609
Phone (919) 538-5459
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | C009632 | NC | Yes |
Addresses
Primary practice location
8338 NC Highway 39 S
Henderson, NC 27537-7132
Mailing address
8338 NC Highway 39 S
Henderson, NC 27537-7132
Phone (919) 538-5459
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C009362 | Other | NC | LCSW LICENSE |
Other names
- Agape Recovery Center, PLLC
Other providers in Henderson, NC
- Adept Physicians PLLC
- Johnathan Todd Adkins
- Adore Home Health LLC
- Advantage Care in Home Services, Inc
- Aes Medical PC
- Munirah Ali
- April Allen
- Alpha Omega Health, Inc
- Tamika L Alston
- Alternative Behavioral Concepts, LLC
All providers in Henderson, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.