Provider Demographics
NPI:1386895159
Name:INVINCIBLE COMMUNITY BASED SERVICES LLC
Entity type:Organization
Organization Name:INVINCIBLE COMMUNITY BASED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:252-541-1576
Mailing Address - Street 1:1015 ROANOKE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3721
Mailing Address - Country:US
Mailing Address - Phone:252-541-1576
Mailing Address - Fax:252-541-1577
Practice Address - Street 1:1015 ROANOKE AVE STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3721
Practice Address - Country:US
Practice Address - Phone:252-541-1576
Practice Address - Fax:252-541-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC200815700098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health