Healthcare Provider Details

I. General information

NPI: 1760679997
Provider Name (Legal Business Name): JEFFREY GEORGE HURD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N EUGENE ST
GREENSBORO NC
27401-2221
US

IV. Provider business mailing address

201 N EUGENE ST
GREENSBORO NC
27401-2221
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-3630
  • Fax: 336-641-3580
Mailing address:
  • Phone: 336-641-3630
  • Fax: 336-641-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000715
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: