Provider Demographics
NPI:1851464150
Name:NC RECOVERY SUPPORT SERVICES
Entity Type:Organization
Organization Name:NC RECOVERY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:919-320-4981
Mailing Address - Street 1:1100 NAVAHO DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7319
Mailing Address - Country:US
Mailing Address - Phone:919-431-9874
Mailing Address - Fax:919-550-9438
Practice Address - Street 1:1100 NAVAHO DR
Practice Address - Street 2:SUITE 125
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7319
Practice Address - Country:US
Practice Address - Phone:919-431-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X, 251B00000X
NC779251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110542Medicaid
NC6111830Medicaid
NC8916145Medicaid