NPIMap

Organization Active NPI

Community Support Specialists, LLC

  • Mental Health Counselor
  • Wilmington, NC
National Provider Identifier
1992997167
Registry record updated May 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
COMMUNITY SUPPORT SPECIALISTS, LLC
Practice address
1316 S 16TH St
Wilmington, NC 28401-6422
Phone
(910) 763-3644
Fax
(910) 763-3634
NPI assigned
Aug 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2010

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

Authorized official

Name
Ms. Annie Della Kenion, RN
Title
Director/Qualified Professional
Phone
(910) 763-3644

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1316 S 16TH St
Wilmington, NC 28401-6422

Mailing address

1316 S 16TH St
Wilmington, NC 28401-6422
Phone (910) 763-3644

Other identifiers 2

IdentifierTypeStateIssuer
6106835MedicaidNC
89138HRMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Community Support Specialists5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274140800000",
    "number": "1992997167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016422",
            "telephone_number": "910-763-3644",
            "fax_number": "910-763-3634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016422",
            "telephone_number": "910-763-3644",
            "fax_number": "910-763-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2010-05-18",
        "status": "A",
        "authorized_official_last_name": "KENION",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_middle_name": "DELLA",
        "authorized_official_title_or_position": "DIRECTOR/QUALIFIED PROFESSIONAL",
        "authorized_official_telephone_number": "910-763-3644",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106835",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89138HR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 18, 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.