Healthcare Provider Details

I. General information

NPI: 1114079373
Provider Name (Legal Business Name): THERAPEUTIC ALTERNATIVES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BAKER RD
ARCHDALE NC
27263-2758
US

IV. Provider business mailing address

PO BOX 814
RANDLEMAN NC
27317-0814
US

V. Phone/Fax

Practice location:
  • Phone: 336-862-7220
  • Fax:
Mailing address:
  • Phone: 336-495-2723
  • Fax: 336-495-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID DEAN WILSON
Title or Position: OWNER
Credential:
Phone: 336-495-2700