Provider Demographics
NPI:1689841009
Name:STONEBRAKER'S INC.
Entity Type:Organization
Organization Name:STONEBRAKER'S INC.
Other - Org Name:THE INSIGHT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STONEBRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CCS, CSAC
Authorized Official - Phone:336-852-3033
Mailing Address - Street 1:3714 ALLIANCE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2060
Mailing Address - Country:US
Mailing Address - Phone:336-852-3033
Mailing Address - Fax:336-852-3133
Practice Address - Street 1:3714 ALLIANCE DR STE 400
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2060
Practice Address - Country:US
Practice Address - Phone:336-852-3033
Practice Address - Fax:336-852-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-742101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty