Provider Demographics
NPI:1053671396
Name:W&G COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:W&G COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-851-9000
Mailing Address - Street 1:128 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-8106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7612 HWY 52 SOUTH
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:NC
Practice Address - Zip Code:28119
Practice Address - Country:US
Practice Address - Phone:704-851-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-004-034320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities