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General NPI Number Information
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NPI Number | 1194070771
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Entity Type | Organization
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Legal Business Name | WORTHINGTON CENTER
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1537 LOVETT ST
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City | GREENSBORO
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State | NC
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Zip | 27403-3340
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Country | US
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Telephone | 336-965-5922
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 LOVETT ST
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City | GREENSBORO
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State | NC
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Zip | 27403-3340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MARSHALL WORTHINGTON
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Credential |
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Telephone | 336-965-5922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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