Healthcare Provider Details

I. General information

NPI: 1245168715
Provider Name (Legal Business Name): AYLA MAZIAH VANEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 GRIMSLEY ST
GREENSBORO NC
27403-3135
US

IV. Provider business mailing address

3800 OAKCLIFFE RD
GREENSBORO NC
27406-8606
US

V. Phone/Fax

Practice location:
  • Phone: 336-279-1226
  • Fax: 336-279-1226
Mailing address:
  • Phone: 336-929-0933
  • Fax: 336-279-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: