Healthcare Provider Details

I. General information

NPI: 1013027341
Provider Name (Legal Business Name): ADOLESCENT ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 LONGBROOK DR
GREENSBORO NC
27406-9448
US

IV. Provider business mailing address

PO BOX 16162
GREENSBORO NC
27416-0162
US

V. Phone/Fax

Practice location:
  • Phone: 336-370-9876
  • Fax:
Mailing address:
  • Phone: 336-370-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-041-731
License Number StateNC

VIII. Authorized Official

Name: SHIRENA SIMPSON-SMITH
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: MSW-LCSW
Phone: 336-451-1113