Provider Demographics
NPI:1245066323
Name:NATIONAL COUNSEL FOR COMMUNITY SUPPORT, LLC
Entity type:Organization
Organization Name:NATIONAL COUNSEL FOR COMMUNITY SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUHULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSADIQ
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:352-584-0416
Mailing Address - Street 1:5104 REAGAN DR STE 5
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1392
Mailing Address - Country:US
Mailing Address - Phone:352-584-0416
Mailing Address - Fax:
Practice Address - Street 1:5104 REAGAN DR STE 5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1392
Practice Address - Country:US
Practice Address - Phone:352-584-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty