Healthcare Provider Details

I. General information

NPI: 1871310144
Provider Name (Legal Business Name): PEACHTREE LEARNING COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S GREENE ST STE 8C
GREENSBORO NC
27401-3252
US

IV. Provider business mailing address

301 S GREENE ST STE 8C
GREENSBORO NC
27401-3252
US

V. Phone/Fax

Practice location:
  • Phone: 336-539-1967
  • Fax:
Mailing address:
  • Phone: 336-539-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIANNA JUANITA HUTCHINSON
Title or Position: OWNER, DIRECTOR
Credential: BCBA, LBA
Phone: 470-262-5112