Provider Demographics
NPI:1396153136
Name:SOUTHEAST SUPPORT SERVICES
Entity type:Organization
Organization Name:SOUTHEAST SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-471-8130
Mailing Address - Street 1:PO BOX 4094
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-4094
Mailing Address - Country:US
Mailing Address - Phone:336-471-8130
Mailing Address - Fax:
Practice Address - Street 1:139 ALTAMA CONNECTOR # 193
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1888
Practice Address - Country:US
Practice Address - Phone:336-471-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health