Healthcare Provider Details

I. General information

NPI: 1952799603
Provider Name (Legal Business Name): EVALUATION AND EDUCATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 BRIARCLIFFE RD
WINSTON SALEM NC
27106
US

IV. Provider business mailing address

2910 BRIARCLIFFE RD
WINSTON SALEM NC
27106-3176
US

V. Phone/Fax

Practice location:
  • Phone: 336-245-8161
  • Fax: 336-773-0332
Mailing address:
  • Phone: 336-245-8161
  • Fax: 336-773-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS2165
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLPA4067
License Number StateNC

VIII. Authorized Official

Name: ANDREW P. IRWIN-SMILER
Title or Position: SOLE PROPRIETOR
Credential: PHD
Phone: 336-245-8161