Provider Demographics
NPI:1235475609
Name:SOUTHERN SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMTD
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSWA
Authorized Official - Phone:252-702-9176
Mailing Address - Street 1:514 2ND LOOP RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2848
Mailing Address - Country:US
Mailing Address - Phone:843-665-5181
Mailing Address - Fax:843-665-5189
Practice Address - Street 1:514 2ND LOOP RD
Practice Address - Street 2:SUITE C
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2848
Practice Address - Country:US
Practice Address - Phone:843-665-5181
Practice Address - Fax:843-665-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health