Provider Demographics
NPI:1043528433
Name:GUILFORD COUNTY COMMUNITY CONNECTIONS, INC.
Entity Type:Organization
Organization Name:GUILFORD COUNTY COMMUNITY CONNECTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALSTON WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-3003
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-1026
Mailing Address - Country:US
Mailing Address - Phone:336-882-6549
Mailing Address - Fax:336-882-6550
Practice Address - Street 1:808 W ENGLISH RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-6818
Practice Address - Country:US
Practice Address - Phone:336-882-6549
Practice Address - Fax:336-882-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NCC001771104100000X
NC1109712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302622Medicaid