Healthcare Provider Details

I. General information

NPI: 1982942561
Provider Name (Legal Business Name): THERAPEUTIC ALTERNATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 S FAYETTEVILLE ST
ASHEBORO NC
27203-6591
US

IV. Provider business mailing address

962 S FAYETTEVILLE ST
ASHEBORO NC
27203-6591
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-1759
  • Fax: 336-625-2767
Mailing address:
  • Phone: 336-626-1759
  • Fax: 336-625-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number006308
License Number StateNC

VIII. Authorized Official

Name: KENNY BURROWS
Title or Position: CEO
Credential:
Phone: 336-495-2712