Healthcare Provider Details

I. General information

NPI: 1487634507
Provider Name (Legal Business Name): HALIMENA MONTCLAIRE CREQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BETHESDA PLACE #801 FAMILY BEHAVIORAL HEALTH
WINSTON-SALEM NC
27103
US

IV. Provider business mailing address

3000 BETHESDA PLACE #801 FAMILY BEHAVIORAL HEALTH
WINSTON- SALEM NC
27103
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9141
  • Fax: 336-659-1456
Mailing address:
  • Phone: 336-659-9141
  • Fax: 336-659-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: