Provider Demographics
NPI:1093174914
Name:TEARS OF AN ADDICT, LLC
Entity Type:Organization
Organization Name:TEARS OF AN ADDICT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SOMBELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-686-2867
Mailing Address - Street 1:1015 GLENDALE DR APT 15D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6456
Mailing Address - Country:US
Mailing Address - Phone:336-686-2867
Mailing Address - Fax:
Practice Address - Street 1:818 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3814
Practice Address - Country:US
Practice Address - Phone:336-686-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health