Provider Demographics
NPI:1447393020
Name:COMMUNITY SUPPORT AGENCY, LLC
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVORIA
Authorized Official - Middle Name:KEATON
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-655-0698
Mailing Address - Street 1:P.O BOX 465
Mailing Address - Street 2:
Mailing Address - City:DELCO
Mailing Address - State:NC
Mailing Address - Zip Code:28436-9221
Mailing Address - Country:US
Mailing Address - Phone:910-655-0698
Mailing Address - Fax:910-655-0611
Practice Address - Street 1:44 DREAM AVE
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-8700
Practice Address - Country:US
Practice Address - Phone:910-297-4230
Practice Address - Fax:910-297-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health