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General NPI Number Information
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NPI Number | 1366699449
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Entity Type | Organization
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Legal Business Name | PIEDMONT BEHAVIORAL RESOURCES, INC.
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 201 W. MARION ST. STE. 207
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City | SHELBY
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State | NC
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Zip | 28150
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Country | US
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Telephone | 704-487-6226
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Fax | 704-487-6286
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Provider Business Mailing Address
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Address Line | 201 W. MARION ST. STE. 207
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City | SHELBY
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State | NC
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Zip | 28150
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Country | US
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Telephone | 704-487-6226
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Fax | 704-487-6286
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Authorized Official
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Title or Position | CEO
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Name | TANZY BARROW WALLACE
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Credential |
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Telephone | 704-487-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 229
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MHL-023-148
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1135
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 366
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License Number State | NC
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5595
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License Number State | NC
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Taxonomy #7
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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 #8
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-023-046
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License Number State | NC
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Taxonomy #9
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | NC
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