Provider Demographics
NPI:1568530061
Name:DOVE SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:DOVE SUPPORTIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-786-4388
Mailing Address - Street 1:3900 BARRETT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6614
Mailing Address - Country:US
Mailing Address - Phone:919-786-4388
Mailing Address - Fax:919-786-4399
Practice Address - Street 1:3900 BARRETT DR
Practice Address - Street 2:STE. 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6641
Practice Address - Country:US
Practice Address - Phone:919-786-4388
Practice Address - Fax:919-786-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301564Medicaid