Provider Demographics
NPI:1316359961
Name:WINFORD BROWN RAMSEUR & ASSOC
Entity Type:Organization
Organization Name:WINFORD BROWN RAMSEUR & ASSOC
Other - Org Name:ESSENTIAL LIFE CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATRINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS
Authorized Official - Phone:336-896-9771
Mailing Address - Street 1:4680 BROWNSBORO RD # D
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3428
Mailing Address - Country:US
Mailing Address - Phone:336-896-9771
Mailing Address - Fax:
Practice Address - Street 1:132 COURT ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5803
Practice Address - Country:US
Practice Address - Phone:980-223-2084
Practice Address - Fax:336-464-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-034-265251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306036470Medicaid
NC1629313051Medicaid
NC1780865535Medicaid
NC1205972205Medicaid
NC1952535858Medicaid
NC1366654329Medicaid