MEDICARE: JOURNEYS COUNSELING CENTER INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	1041C0700X	Clinical Social Worker
4	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982907838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEYS COUNSELING CENTER INC.

Provider Business Mailing Address
First Line	:	612 PASTEUR DR STE 400
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1120
Country	:	US
Telephone Number	:	336-294-1349
Fax Number	:	336-292-6711

Provider Business Practice Location Address
First Line	:	3405 W WENDOVER AVE STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1525
Country	:	US
Telephone Number	:	336-294-1349
Fax Number	:	336-292-6711

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHIRENA SIMPSON SMITH
Credential	:	LCSW
Telephone Number	:	336-451-1113

Provider Enumeration Date	:	12/15/2010
Last Update Date	:	08/30/2022

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