Basic Information
| Provider Information | |||||||||
| NPI: | 1881196418 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESPONDER SUPPORT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 HIGH LAKE DR | ||||||||
| Address2: | |||||||||
| City: | NEBO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287619421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287790544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 204 CHARLOTTE HWY STE E | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288038681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283335708 | ||||||||
| FaxNumber: | 8384841025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8287790544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, LPCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.