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CROWN LEGACY SUPPORTIVE SERVICESLLC NPI 1326435314


NPI Information

NPI: 1326435314
Provider Name: CROWN LEGACY SUPPORTIVE SERVICESLLC

Other Name: BRADLEY-REID CORPORATION

Classification: Social Worker - 1041C0700X
Entity Type: Organization

Specialization: Clinical

Address:
715 E 5TH ST
SUITE 216
CHARLOTTE, NC
ZIP 28202
Phone: (704) 333-5686
Get Directions

CROWN LEGACY SUPPORTIVE SERVICESLLC is a clinical social worker in Charlotte, NC. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. CROWN LEGACY SUPPORTIVE SERVICESLLC NPI is 1326435314. The provider is registered as an organization entity type.
The provider Other Name Is Bradley-reid Corporation.

The provider's business location address is:

715 E 5TH ST
SUITE 216
CHARLOTTE, NC
ZIP 28202-001
Phone: (704) 333-5686
Fax: (704) 376-1931

The provider's authorized official is Sandra Bradley Reid .
The authorized official title is Chief Executive Officer and has the following contact phone number (704) 333-5686.

The enumeration date for this NPI number is 4/17/2015 and was last updated on 4/17/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251B00000XCase ManagementNo
2251S00000XCommunity/Behavioral HealthNo
3252Y00000XEarly Intervention Provider AgencyNo
4253Z00000XIn Home Supportive CareNo
5347C00000XPrivate VehicleNo
6385H00000XRespite CareNo
71041C0700XSocial WorkerClinicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16008557MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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