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General NPI Number Information
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NPI Number | 1992246680
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Entity Type | Organization
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Legal Business Name | THE DOLLIN GROUP, LLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 2300 SOABAR ST BOX 16205
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City | GREENSBORO
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State | NC
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Zip | 27406-3650
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Country | US
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Telephone | 336-681-0655
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Fax | 336-272-2387
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Provider Business Mailing Address
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Address Line | 2616 GLENHAVEN LN
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City | WINSTON SALEM
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State | NC
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Zip | 27106-2317
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Country | US
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Telephone | 336-681-0655
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Fax | 336-272-2387
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Authorized Official
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Title or Position | CEO
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Name | WILLIE F. PICKENS
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Credential |
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Telephone | 336-681-0655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | MHL-041-071
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License Number State | NC
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