Provider Demographics
NPI:1366749780
Name:E SQUARED COMMUNITY SERVICES
Entity type:Organization
Organization Name:E SQUARED COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-218-7161
Mailing Address - Street 1:5022 ISABELLA CANNON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4804
Mailing Address - Country:US
Mailing Address - Phone:919-218-7161
Mailing Address - Fax:919-327-6813
Practice Address - Street 1:105 N RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2130
Practice Address - Country:US
Practice Address - Phone:704-994-2640
Practice Address - Fax:704-994-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-004-030251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301695Medicaid