Healthcare Provider Details

I. General information

NPI: 1730031998
Provider Name (Legal Business Name): MINDBRIDGE BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 ROSLYN RD
WINSTON SALEM NC
27104-2036
US

IV. Provider business mailing address

408 ROSLYN RD
WINSTON SALEM NC
27104-2036
US

V. Phone/Fax

Practice location:
  • Phone: 336-407-8135
  • Fax:
Mailing address:
  • Phone: 336-407-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAUREN NICOLE STOKES
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 336-416-8523