Provider Demographics
NPI:1417132366
Name:AGAPE SERVICES INC
Entity Type:Organization
Organization Name:AGAPE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-225-0584
Mailing Address - Street 1:PO BOX 3319
Mailing Address - Street 2:806 CIRCLE DRIVE
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-3319
Mailing Address - Country:US
Mailing Address - Phone:704-225-0584
Mailing Address - Fax:704-225-1479
Practice Address - Street 1:806 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-3800
Practice Address - Country:US
Practice Address - Phone:704-225-0584
Practice Address - Fax:704-225-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303172Medicaid
NC8301179Medicaid