Provider Demographics
NPI:1649392424
Name:THERAPEUTIC BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-299-0754
Mailing Address - Street 1:PO BOX 77165
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417-7165
Mailing Address - Country:US
Mailing Address - Phone:336-299-0754
Mailing Address - Fax:336-299-0755
Practice Address - Street 1:1527 EARL DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4807
Practice Address - Country:US
Practice Address - Phone:336-299-0754
Practice Address - Fax:336-299-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301297BMedicaid