Healthcare Provider Details

I. General information

NPI: 1477462489
Provider Name (Legal Business Name): TRI-STATE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 SPRING GARDEN ST
GREENSBORO NC
27407-1609
US

IV. Provider business mailing address

717 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-2156
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-4801
  • Fax:
Mailing address:
  • Phone: 336-544-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VALORIE YVONNE ENOCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-687-3759