| Community Prevention Services, Inc. | |
|
918 Henderson Dr Jacksonville NC 28540-7420 | |
| (910) 353-0972 | |
| (910) 353-1439 |
| Full Name | Community Prevention Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 918 Henderson Dr, Jacksonville, North Carolina |
| Authorized Official Name and Position | Kelli Knapp (VICE PRESIDENT) |
| Authorized Official Contact | 9103530972 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Prevention Services, Inc. 918 Henderson Dr Jacksonville NC 28540-7420 Ph: (910) 353-0972 | Community Prevention Services, Inc. 918 Henderson Dr Jacksonville NC 28540-7420 Ph: (910) 353-0972 |
| NPI Number | 1801489943 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 1254772429 |
|---|---|
| Medicare Enrollment ID | O20240520000364 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801489943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kelli Carter Knapp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730627761 PECOS PAC ID: 6709227978 Enrollment ID: I20240520000474 |
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