Provider Demographics
NPI:1669925681
Name:MBS HEALTH & WELLNESS SOLUTIONS, LLC
Entity type:Organization
Organization Name:MBS HEALTH & WELLNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHUKAIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:980-474-7757
Mailing Address - Street 1:331 E MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5383
Mailing Address - Country:US
Mailing Address - Phone:980-474-7757
Mailing Address - Fax:
Practice Address - Street 1:331 E MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5383
Practice Address - Country:US
Practice Address - Phone:980-474-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL0215101YA0400X
NCC0083891041C0700X
SCCP-110941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659666444Medicaid
NC1659666444Medicaid