Healthcare Provider Details

I. General information

NPI: 1245381169
Provider Name (Legal Business Name): THE AC GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W INDEPENDENCE BLVD SUITE 200
MOUNT AIRY NC
27030-3589
US

IV. Provider business mailing address

107 W INDEPENDENCE BLVD SUITE 200
MOUNT AIRY NC
27030-3589
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-5855
  • Fax: 336-786-4769
Mailing address:
  • Phone: 336-786-5855
  • Fax: 336-786-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TEREIA SIDDEN COOK
Title or Position: PRESIDENT
Credential: MA, LCAS, LPC, CCS
Phone: 336-786-5855