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General NPI Number Information
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NPI Number | 1699266445
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Entity Type | Organization
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Legal Business Name | THE OIL GROUP
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Dates
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Enumeration Date | 05/27/2018
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Last Update Date | 05/27/2018
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Provider Practice Location Address
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Address Line | 1451 S ELM EUGENE ST STE 2009
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City | GREENSBORO
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State | NC
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Zip | 27406-2200
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Country | US
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Telephone | 336-457-2748
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Fax | 336-464-2544
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Provider Business Mailing Address
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Address Line | 1451 S ELM EUGENE ST STE 2009
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City | GREENSBORO
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State | NC
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Zip | 27406-2200
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Country | US
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Telephone | 336-457-2748
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Fax | 336-464-2544
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Authorized Official
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Title or Position | OWNER AND LICENSED THERAPIST
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Name | JONATHAN DANIEL WOODBURY
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Credential | LCAS, LPCA
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Telephone | 336-457-2748
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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 | 20411
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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 | A13656
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A13656
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License Number State | NC
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