Supreme Teens, L&C

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SUPREME TEENS, L&C

Practice address

14495 Hwy 301 N.
Enfield, NC 27823

Phone

(252) 467-3407

Fax

(252) 445-1073

NPI assigned

May 21, 2012

Last updated

May 21, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Trevathan Marquette El

Title

Director/Coordinator

Phone

(252) 467-3407

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1689934077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14495 HWY 301 N.",
            "city": "ENFIELD",
            "state": "NC",
            "postal_code": "27823",
            "telephone_number": "252-467-3407",
            "fax_number": "252-445-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14495 HWY 301 N.",
            "city": "ENFIELD",
            "state": "NC",
            "postal_code": "27823",
            "telephone_number": "252-467-3407",
            "fax_number": "252-445-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME TEENS, L&C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "MARQUETTE EL",
        "authorized_official_first_name": "TREVATHAN",
        "authorized_official_title_or_position": "DIRECTOR/COORDINATOR",
        "authorized_official_telephone_number": "252-467-3407"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Enfield, NC
• Providers in Enfield, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; 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.