Provider Demographics
NPI:1346552056
Name:ASPIRE SUPPORTIVE & COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ASPIRE SUPPORTIVE & COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COUSAR
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QP
Authorized Official - Phone:919-210-3774
Mailing Address - Street 1:117 PENNSYLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3415
Mailing Address - Country:US
Mailing Address - Phone:919-835-1888
Mailing Address - Fax:919-835-1889
Practice Address - Street 1:117 PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3415
Practice Address - Country:US
Practice Address - Phone:919-835-1888
Practice Address - Fax:919-835-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC0700X, 103TC1900X, 103TP2701X, 104100000X, 1041C0700X, 251B00000X, 251S00000X
NC1577251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty