Provider Demographics
NPI:1598844565
Name:PROFESSIONAL REHABILITATION CONSULTANTS
Entity Type:Organization
Organization Name:PROFESSIONAL REHABILITATION CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ZAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LICCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:CRC
Authorized Official - Phone:336-508-1157
Mailing Address - Street 1:1710 KAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5046
Mailing Address - Country:US
Mailing Address - Phone:336-508-1157
Mailing Address - Fax:
Practice Address - Street 1:1710 KAY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5046
Practice Address - Country:US
Practice Address - Phone:336-508-1157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty