Provider Demographics
NPI:1912211798
Name:PYRAMID SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:PYRAMID SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VACTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:256-715-1050
Mailing Address - Street 1:2002 POOLE DR NW
Mailing Address - Street 2:SUITE #D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3887
Mailing Address - Country:US
Mailing Address - Phone:256-715-1050
Mailing Address - Fax:
Practice Address - Street 1:2002 POOLE DR NW
Practice Address - Street 2:SUITE #D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3887
Practice Address - Country:US
Practice Address - Phone:256-715-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1692C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty