Healthcare Provider Details

I. General information

NPI: 1144405689
Provider Name (Legal Business Name): ADVANCED HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S SCALES ST STE B
REIDSVILLE NC
27320-5338
US

IV. Provider business mailing address

1218 COPELAND OAKS DR
MORRISVILLE NC
27560-6614
US

V. Phone/Fax

Practice location:
  • Phone: 336-347-3330
  • Fax:
Mailing address:
  • Phone: 919-465-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALFRED POTTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-465-3277