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General NPI Number Information
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NPI Number | 1720724669
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Entity Type | Organization
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Legal Business Name | TURTLEDOVE, LLC
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 2594 REYNOLDA RD STE D
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4601
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Country | US
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Telephone | 336-978-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 970 FOREST GROVE DR
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City | WINSTON SALEM
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State | NC
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Zip | 27104-1445
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Country | US
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Telephone | 336-978-5324
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | RENEE COLCLOUGH HINSON
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Credential | PHD
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Telephone | 336-978-5324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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