Provider Demographics
NPI:1467592436
Name:FIRST STEP DIRECT CARE, INC
Entity Type:Organization
Organization Name:FIRST STEP DIRECT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-280-9263
Mailing Address - Street 1:PO BOX 668683
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8683
Mailing Address - Country:US
Mailing Address - Phone:704-395-2432
Mailing Address - Fax:704-395-2432
Practice Address - Street 1:320 WINDING CANYON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-5013
Practice Address - Country:US
Practice Address - Phone:704-395-2432
Practice Address - Fax:704-395-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL060709320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities