Healthcare Provider Details

I. General information

NPI: 1487997748
Provider Name (Legal Business Name): PIEDMONT COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 ALLEN ST
KERNERSVILLE NC
27284
US

IV. Provider business mailing address

129 ALLEN ST
KERNERSVILLE NC
27284-2940
US

V. Phone/Fax

Practice location:
  • Phone: 336-293-7406
  • Fax: 336-261-6365
Mailing address:
  • Phone: 336-293-7406
  • Fax: 336-261-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number925
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4105
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007838
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2015-01928
License Number StateNC

VIII. Authorized Official

Name: DR. JERRY DAVID SPRIGGS JR.
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 336-293-7406