Healthcare Provider Details

I. General information

NPI: 1871203224
Provider Name (Legal Business Name): BIRCH GROVE COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 HOLLY AVE
WINSTON SALEM NC
27101-2716
US

IV. Provider business mailing address

632 HOLLY AVE
WINSTON SALEM NC
27101-2716
US

V. Phone/Fax

Practice location:
  • Phone: 336-816-4239
  • Fax:
Mailing address:
  • Phone: 336-816-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNAMARIE GALLAGHER
Title or Position: OWNER
Credential: LCMHCS
Phone: 336-816-4239