Provider Demographics
NPI:1467822841
Name:JUAN BAUTISTA SANTOS
Entity Type:Organization
Organization Name:JUAN BAUTISTA SANTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:BAUTISTA
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CRC, LPCA
Authorized Official - Phone:336-707-1723
Mailing Address - Street 1:3300 BATTLEGROUND AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2491
Mailing Address - Country:US
Mailing Address - Phone:336-707-1723
Mailing Address - Fax:
Practice Address - Street 1:3300 BATTLEGROUND AVE STE 303
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2491
Practice Address - Country:US
Practice Address - Phone:336-707-1723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty