Healthcare Provider Details

I. General information

NPI: 1093805483
Provider Name (Legal Business Name): STEP BY STEP CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 EAST MARKET STREET SUITE 100 B
GREENSBORO NC
27401
US

IV. Provider business mailing address

709 EAST MARKET STREET SUITE 100 B
GREENSBORO NC
27401
US

V. Phone/Fax

Practice location:
  • Phone: 336-378-0109
  • Fax:
Mailing address:
  • Phone: 336-378-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8300896
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAVONDELL RISOTTO STALLINGS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-378-0109