Provider Demographics
NPI:1073748992
Name:COMMUNITY CONNECTIONS HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY CONNECTIONS HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLESHA
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-665-4673
Mailing Address - Street 1:5816 CREEDMOOR RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2310
Mailing Address - Country:US
Mailing Address - Phone:919-665-4673
Mailing Address - Fax:919-882-8348
Practice Address - Street 1:5816 CREEDMOOR RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:919-665-4673
Practice Address - Fax:919-882-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008124Medicaid
NC6006833Medicaid