Healthcare Provider Details

I. General information

NPI: 1760327316
Provider Name (Legal Business Name): ALTHEA RECOVERY TRANSFORMATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 KONNOAK VILLAGE CIR
WINSTON SALEM NC
27127-6118
US

IV. Provider business mailing address

122 KONNOAK VILLAGE CIR
WINSTON SALEM NC
27127-6118
US

V. Phone/Fax

Practice location:
  • Phone: 336-965-9137
  • Fax:
Mailing address:
  • Phone: 336-965-9137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: ALTHEA DORTCH
Title or Position: OWNER
Credential: LCSW-A, LCASA, CDC
Phone: 336-965-9137