| Josephs Com Support Services Inc | |
|
1501 N Queen St Kinston NC 28501-2944 | |
| (252) 520-2001 | |
| (252) 520-0024 |
| Full Name | Josephs Com Support Services Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1501 N Queen St, Kinston, North Carolina |
| Authorized Official Name and Position | Tamaria Mccollum (PRESIDENT/OWNER) |
| Authorized Official Contact | 2525202001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Josephs Com Support Services Inc 1501 N Queen St Kinston NC 28501-2944 Ph: (252) 520-2001 | Josephs Com Support Services Inc 1501 N Queen St Kinston NC 28501-2944 Ph: (252) 520-2001 |
| NPI Number | 1215120720 |
|---|---|
| Provider Enumeration Date | 08/20/2007 |
| Last Update Date | 05/16/2016 |
| Medicare PECOS PAC ID | 0749579811 |
|---|---|
| Medicare Enrollment ID | O20160512000684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215120720 | NPI | - | NPPES |
| 8302119 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kuliakanda M Chengappa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376558825 PECOS PAC ID: 7214957588 Enrollment ID: I20051201000230 |
| Provider Name | Leychia E Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528200979 PECOS PAC ID: 5799085650 Enrollment ID: I20151125000002 |
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