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General NPI Number Information
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NPI Number | 1750868071
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Entity Type | Organization
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Legal Business Name | BALANCE & VITALITY, PLLC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 2309 W CONE BLVD STE 218
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City | GREENSBORO
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State | NC
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Zip | 27408-4047
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Country | US
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Telephone | 336-410-4161
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Fax | 336-436-9141
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Provider Business Mailing Address
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Address Line | 2309 W CONE BLVD STE 218
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City | GREENSBORO
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State | NC
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Zip | 27408-4047
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Country | US
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Telephone | 336-410-4161
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Fax | 336-436-9141
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | FATIMA JORDAN
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Credential | MS, LPC, LCASA
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Telephone | 336-410-4161
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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 |
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License Number State |
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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 |
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License Number State |
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