| Supportive Community Services Llc | |
|
2432 W Peoria Ave Phoenix AZ 85029-4726 | |
| (702) 526-4573 | |
| (702) 202-1180 |
| Full Name | Supportive Community Services Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2432 W Peoria Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Niesha S. Allen (DIRECTOR) |
| Authorized Official Contact | 7025264573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Community Services Llc 3454 Whitman Falls Dr Las Vegas NV 89129-6355 Ph: (702) 526-4573 | Supportive Community Services Llc 2432 W Peoria Ave Phoenix AZ 85029-4726 Ph: (702) 526-4573 |
| NPI Number | 1770123614 |
|---|---|
| Provider Enumeration Date | 01/08/2020 |
| Last Update Date | 01/08/2020 |
| Certification Date | 01/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770123614 | NPI | - | NPPES |
| 1720451672 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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