Provider Demographics
NPI:1275824864
Name:DIVERSIFIED COMMUNITY CONNECTIONS,LLC
Entity Type:Organization
Organization Name:DIVERSIFIED COMMUNITY CONNECTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ALSTON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-623-9942
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-0504
Mailing Address - Country:US
Mailing Address - Phone:252-508-4445
Mailing Address - Fax:252-508-4445
Practice Address - Street 1:1112 NAI RAD LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-7897
Practice Address - Country:US
Practice Address - Phone:252-508-4445
Practice Address - Fax:252-508-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty