Provider Demographics
NPI:1497914485
Name:PIEDMONT BEHAVIORAL COUNSELING CENTER
Entity Type:Organization
Organization Name:PIEDMONT BEHAVIORAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-896-0082
Mailing Address - Street 1:4401 CHERRY ST STE 60
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-2500
Mailing Address - Country:US
Mailing Address - Phone:336-896-0062
Mailing Address - Fax:
Practice Address - Street 1:4401 CHERRY ST STE 60
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2500
Practice Address - Country:US
Practice Address - Phone:336-896-0062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health