Provider Demographics
NPI:1629538350
Name:PROFESSIONAL RESOURCES ENHANCING PERSONAL SUCCESS LLP
Entity Type:Organization
Organization Name:PROFESSIONAL RESOURCES ENHANCING PERSONAL SUCCESS LLP
Other - Org Name:PROFESSIONAL RESOURCES ENHANCING PERSONAL SUCCESS LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-712-1277
Mailing Address - Street 1:1800 CAMDEN RD STE 107-137
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4690
Mailing Address - Country:US
Mailing Address - Phone:704-712-1277
Mailing Address - Fax:
Practice Address - Street 1:4921 ALBEMARLE RD STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6654
Practice Address - Country:US
Practice Address - Phone:980-819-6585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629538350Medicaid
NC1902385172Medicaid