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NPI Code Detail

MEDICARE: VILLAGE LIFE CATHEDRAL, INC

MEDICARE: VILLAGE LIFE CATHEDRAL, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1144904343
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLAGE LIFE CATHEDRAL, INC
Provider Business Mailing Address
First Line : 1619 W WARD AVE
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-1535
Country : US
Telephone Number : 336-882-0025
Fax Number :
Provider Business Practice Location Address
First Line : 1619 W WARD AVE
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-1535
Country : US
Telephone Number : 336-882-0025
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MR. DARRYL MCCARROLL
Credential : LCSW
Telephone Number : 336-987-0333
Provider Enumeration Date : 06/09/2023
Last Update Date : 06/20/2023

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Directions to “VILLAGE LIFE CATHEDRAL, INC ” Practice Location

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