Provider Demographics
NPI:1730243205
Name:E SQUARED COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:E SQUARED COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-218-7161
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5830
Mailing Address - Country:US
Mailing Address - Phone:910-891-7680
Mailing Address - Fax:910-891-7682
Practice Address - Street 1:608A W BROAD ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4812
Practice Address - Country:US
Practice Address - Phone:910-891-7680
Practice Address - Fax:910-891-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915537Medicaid
NC8301695Medicaid
NC8301695GMedicaid
NC8301695BMedicaid
NC8301695VMedicaid
NC6005945Medicaid
NC8301695HMedicaid