| Professional Group Living, Llc | |
|
1775 Graham Ave Suite 104 Henderson NC 27536-5948 | |
| (919) 475-5845 | |
| Not Available |
| Full Name | Professional Group Living, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1775 Graham Ave, Henderson, North Carolina |
| Authorized Official Name and Position | Natalka A Lock Massey (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9194755845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Group Living, Llc 1775 Graham Ave Suite 104 Henderson NC 27536-5948 Ph: (919) 475-5845 | Professional Group Living, Llc 1775 Graham Ave Suite 104 Henderson NC 27536-5948 Ph: (919) 475-5845 |
| NPI Number | 1265620421 |
|---|---|
| Provider Enumeration Date | 10/11/2007 |
| Last Update Date | 10/11/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265620421 | NPI | - | NPPES |
| 8302074 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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