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General NPI Number Information
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NPI Number | 1427372655
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Entity Type | Organization
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Legal Business Name | OPENING GATES, LLC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 670 HIGHWAY NINETY TWO
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City | BOYDTON
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State | VA
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Zip | 23917-2234
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Country | US
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Telephone | 434-738-6566
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Fax | 434-738-6566
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Provider Business Mailing Address
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Address Line | 670 HIGHWAY NINETY TWO
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City | BOYDTON
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State | VA
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Zip | 23917-2234
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Country | US
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Telephone | 434-738-6566
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Fax | 434-738-6566
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. MARY ALICE WALTERS
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Credential | LCSW, CSAC, CEAP,
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Telephone | 434-738-6566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904002624
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License Number State | VA
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