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General NPI Number Information
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NPI Number | 1689841009
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Entity Type | Organization
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Legal Business Name | STONEBRAKER'S INC.
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 3714 ALLIANCE DR STE 400
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City | GREENSBORO
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State | NC
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Zip | 27407-2060
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Country | US
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Telephone | 336-852-3033
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Fax | 336-852-3133
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Provider Business Mailing Address
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Address Line | 3714 ALLIANCE DR STE 400
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City | GREENSBORO
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State | NC
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Zip | 27407-2060
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Country | US
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Telephone | 336-852-3033
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Fax | 336-852-3133
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL C. STONEBRAKER
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Credential | CCS, CSAC
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Telephone | 336-852-3033
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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 | MHL-041-742
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License Number State | NC
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