Provider Demographics
NPI:1215122114
Name:SOLUTIONS COMMUNITY SUPPORT AGENCY, LLC
Entity type:Organization
Organization Name:SOLUTIONS COMMUNITY SUPPORT AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MOIR
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:QP
Authorized Official - Phone:336-436-0074
Mailing Address - Street 1:236 N MEBANE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3966
Mailing Address - Country:US
Mailing Address - Phone:336-436-0074
Mailing Address - Fax:336-436-0232
Practice Address - Street 1:236 N MEBANE ST
Practice Address - Street 2:SUITE NUMBER 101
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3966
Practice Address - Country:US
Practice Address - Phone:336-436-0074
Practice Address - Fax:336-436-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 2084P0800X, 363A00000X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302131GMedicaid
NC6006984Medicaid
NC6604457Medicaid
NC8302131HMedicaid
NC5913786Medicaid
NC6603770Medicaid