| Southport Counseling Services, Pllc | |
|
3960 Executive Park Blvd Ste 3 Southport NC 28461-8184 | |
| (910) 854-0371 | |
| (910) 854-0371 |
| Full Name | Southport Counseling Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 3960 Executive Park Blvd Ste 3, Southport, North Carolina |
| Authorized Official Name and Position | Kymra F Stewart (PROVIDER/OWNER) |
| Authorized Official Contact | 8283851889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southport Counseling Services, Pllc 3960 Executive Park Blvd Ste 3 Southport NC 28461-8184 Ph: (910) 854-0371 | Southport Counseling Services, Pllc 3960 Executive Park Blvd Ste 3 Southport NC 28461-8184 Ph: (910) 854-0371 |
| NPI Number | 1942776943 |
|---|---|
| Provider Enumeration Date | 10/17/2018 |
| Last Update Date | 10/17/2018 |
| Medicare PECOS PAC ID | 1557606910 |
|---|---|
| Medicare Enrollment ID | O20181213001391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942776943 | NPI | - | NPPES |
| 79895 | Other | NC | BCBSNC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kymra F Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053348177 PECOS PAC ID: 6204928898 Enrollment ID: I20070828000300 |
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