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General NPI Number Information
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NPI Number | 1790037976
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Entity Type | Organization
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Legal Business Name | A DAY OF DISTINCTION
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 1106 E MARKET ST
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City | GREENSBORO
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State | NC
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Zip | 27401-3267
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Country | US
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Telephone | 336-317-9226
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 E MARKET ST
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City | GREENSBORO
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State | NC
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Zip | 27401-3267
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Country | US
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Telephone | 336-317-9226
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Fax |
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Authorized Official
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Title or Position | QP
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Name | MR. THOMAS RAYMOND WOODSON
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Credential | B.S.
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Telephone | 336-317-9226
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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 | MHL-041-1056
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License Number State | NC
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