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General NPI Number Information
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NPI Number | 1568758324
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Entity Type | Organization
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Legal Business Name | TRAUMA AND ADDICTIONS CENTER, PLLC
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 5603 B NEW GARDEN VILLAGE DR
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City | GREENSBORO
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State | NC
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Zip | 27410-8595
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Country | US
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Telephone | 336-272-8090
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Fax | 336-272-0094
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Provider Business Mailing Address
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Address Line | 5603 B NEW GARDEN VILLAGE DR
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City | GREENSBORO
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State | NC
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Zip | 27410-8595
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Country | US
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Telephone | 336-272-8090
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Fax | 336-272-0094
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Authorized Official
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Title or Position | MEMBER AND ORGANIZER
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Name | DR. KATHERINE HOWARD GLENN
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Credential | PH.D., LPC, LPC-S
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Telephone | 336-272-8090
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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 | 650
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 704
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License Number State | NC
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