Provider Demographics
NPI:1518282201
Name:ALPHA COMMUNITY SUPPORT SERVICE LLC
Entity Type:Organization
Organization Name:ALPHA COMMUNITY SUPPORT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:ELLERBE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QP
Authorized Official - Phone:910-410-0459
Mailing Address - Street 1:114 S HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-3630
Mailing Address - Country:US
Mailing Address - Phone:910-410-0459
Mailing Address - Fax:910-410-0653
Practice Address - Street 1:114 S HANCOCK ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3630
Practice Address - Country:US
Practice Address - Phone:910-410-0459
Practice Address - Fax:910-410-0653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA COMMUNITY SUPPORT SERVICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33577103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006930Medicaid
NC8302367Medicaid