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General NPI Number Information
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NPI Number | 1114697117
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Entity Type | Organization
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Legal Business Name | GREENSBORO DANCE & DRAMA THERAPY
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 4112 SPRING GARDEN ST STE B
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City | GREENSBORO
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State | NC
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Zip | 27407-1652
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Country | US
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Telephone | 336-698-6723
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Fax |
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Provider Business Mailing Address
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Address Line | 5603 W FRIENDLY AVE # 103B
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City | GREENSBORO
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State | NC
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Zip | 27410-4274
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Country | US
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Telephone | 336-698-6723
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA WILEY
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Credential | MA
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Telephone | 336-698-6723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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