Healthcare Provider Details

I. General information

NPI: 1154615805
Provider Name (Legal Business Name): GIVING ME ANOTHER CHANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 05/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WILITON WAY
HIGH POINT NC
27260-5983
US

IV. Provider business mailing address

3340 WILITON WAY
HIGH POINT NC
27260-5983
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-5551
  • Fax:
Mailing address:
  • Phone: 336-883-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY WHITE DAVIS
Title or Position: CO-OWNER
Credential:
Phone: 336-883-5551