Provider Demographics
NPI:1992026892
Name:PIECING IT TOGETHER SERVICES, LLC
Entity Type:Organization
Organization Name:PIECING IT TOGETHER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCP, NBCC
Authorized Official - Phone:910-521-4464
Mailing Address - Street 1:1837 HEZEKIAH RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8679
Mailing Address - Country:US
Mailing Address - Phone:910-521-4464
Mailing Address - Fax:
Practice Address - Street 1:109 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1703
Practice Address - Country:US
Practice Address - Phone:910-521-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-254305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization