Provider Demographics
NPI:1114697117
Name:GREENSBORO DANCE & DRAMA THERAPY
Entity Type:Organization
Organization Name:GREENSBORO DANCE & DRAMA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:336-698-6723
Mailing Address - Street 1:5603 W FRIENDLY AVE # 103B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4274
Mailing Address - Country:US
Mailing Address - Phone:336-698-6723
Mailing Address - Fax:
Practice Address - Street 1:4112 SPRING GARDEN ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1652
Practice Address - Country:US
Practice Address - Phone:336-698-6723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty