Provider Demographics
NPI:1902079346
Name:A NEW START SUPPORT SERVICE, LLC
Entity Type:Organization
Organization Name:A NEW START SUPPORT SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RODRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:919-550-2629
Mailing Address - Street 1:935 SHOTWELL RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5597
Mailing Address - Country:US
Mailing Address - Phone:919-550-2629
Mailing Address - Fax:919-550-6429
Practice Address - Street 1:935 SHOTWELL RD STE 104A
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5597
Practice Address - Country:US
Practice Address - Phone:919-550-2629
Practice Address - Fax:919-550-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X, 251S00000X
NCC0058041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty