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General NPI Number Information
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NPI Number | 1588917165
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS AND CLINICAL SERVICES, PLLC
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Dates
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Enumeration Date | 10/20/2012
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Last Update Date | 10/20/2012
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Provider Practice Location Address
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Address Line | 4215 RIVER BIRCH LOOP APT 2G
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City | GREENSBORO
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State | NC
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Zip | 27409-8042
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Country | US
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Telephone | 336-209-9809
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1624
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City | JAMESTOWN
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State | NC
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Zip | 27282-1624
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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 | MANAGER
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Name | TENIKA WALKER
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Credential |
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Telephone | 336-209-9809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8498
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License Number State | NC
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