Provider Demographics
NPI:1972669299
Name:WATAUGA COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:WATAUGA COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:828-265-8100
Mailing Address - Street 1:132 POPLAR GROVE CONNECTOR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5915
Mailing Address - Country:US
Mailing Address - Phone:828-265-8100
Mailing Address - Fax:828-265-7638
Practice Address - Street 1:132 POPLAR GROVE CONNECTOR
Practice Address - Street 2:SUITE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5915
Practice Address - Country:US
Practice Address - Phone:828-265-8100
Practice Address - Fax:828-265-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104100000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700092OtherMEDICAID AT RISK PROVIDER