MEDICARE: STEP BY STEP CARE, 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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861898116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP BY STEP CARE, INC

Provider Business Mailing Address
First Line	:	709 E MARKET ST
Second Line	:	SUITE 100B
City	:	GREENSBORO
State	:	NC
Zip	:	27401-3265
Country	:	US
Telephone Number	:	336-378-0109
Fax Number	:	336-378-0180

Provider Business Practice Location Address
First Line	:	1320 MAIN ST
Second Line	:	SUITE 300
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3204
Country	:	US
Telephone Number	:	803-724-1250
Fax Number	:	803-724-1201

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. JAVONDELL R STALLINGS
Credential	:
Telephone Number	:	336-689-8902

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	06/20/2018

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