MEDICARE: FORSYTH FAMILY COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C007018	NC

General Provider Information

NPI Number	:	1316362551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORSYTH FAMILY COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	942 W 4TH ST
Second Line	:	SUITE 202
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-2582
Country	:	US
Telephone Number	:	336-777-6160
Fax Number	:	336-546-7630

Provider Business Practice Location Address
First Line	:	942 W 4TH ST
Second Line	:	SUITE 202
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-2582
Country	:	US
Telephone Number	:	336-777-6160
Fax Number	:	336-546-7630

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	MS. LYNN FINLEY
Credential	:	LCSW
Telephone Number	:	336-777-6160

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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