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General NPI Number Information
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NPI Number | 1629459508
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 713 5TH AVE W
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4101
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Country | US
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Telephone | 828-559-3012
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Fax |
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Provider Business Mailing Address
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Address Line | 713 5TH AVE W
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City | HENDERSONVILLE
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State | NC
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Zip | 28739-4101
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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 | DIRECTOR
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Name | SIGNAL WHITE
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Credential |
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Telephone | 336-417-1252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL001241
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License Number State | NC
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