Healthcare Provider Details

I. General information

NPI: 1003966383
Provider Name (Legal Business Name): YADKIN COUNTY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801B RIVER ROAD
BOONVILLE NC
27011-8341
US

IV. Provider business mailing address

121 WASHINGTON ST
YADKINVILLE NC
27055-7725
US

V. Phone/Fax

Practice location:
  • Phone: 336-367-5187
  • Fax: 336-367-3062
Mailing address:
  • Phone: 336-367-5187
  • Fax: 336-367-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberMHL-099-002
License Number StateNC

VIII. Authorized Official

Name: MRS. TERRI MIKLES VESTAL
Title or Position: ADVP DIRECTOR
Credential:
Phone: 33633675187