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General NPI Number Information
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NPI Number | 1205523917
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Entity Type | Organization
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Legal Business Name | IMPACT4TODAY, PLLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 822 N ELM ST STE 109
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City | GREENSBORO
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State | NC
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Zip | 27401-1538
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Country | US
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Telephone | 336-329-8506
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Fax | 336-510-4434
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Provider Business Mailing Address
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Address Line | 822 N ELM ST STE 109
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City | GREENSBORO
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State | NC
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Zip | 27401-1538
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Country | US
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Telephone | 336-329-8506
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Fax | 336-510-4434
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Authorized Official
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Title or Position | CLINICIAN/ OWNER
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Name | MR. MATTHEW DAIL MCMILLAN
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Credential | MS, LCAS, LCMHC, CHT
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Telephone | 336-329-8506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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