Provider Demographics
NPI:1770039323
Name:DEL MAR SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:DEL MAR SUPPORT SERVICES LLC
Other - Org Name:DEL MAR CENTER FOR BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-378-2501
Mailing Address - Street 1:1179 MCCALLISTER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540
Mailing Address - Country:US
Mailing Address - Phone:910-378-2501
Mailing Address - Fax:
Practice Address - Street 1:1179 MCCALLISTER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8796
Practice Address - Country:US
Practice Address - Phone:910-378-2501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-11-6942103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty