Provider Demographics
NPI:1710187703
Name:VISION BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:VISION BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:336-992-0429
Mailing Address - Street 1:495 ARBOR HILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3335
Mailing Address - Country:US
Mailing Address - Phone:336-992-0429
Mailing Address - Fax:336-993-3709
Practice Address - Street 1:495 ARBOR HILL RD STE E
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3335
Practice Address - Country:US
Practice Address - Phone:336-992-0429
Practice Address - Fax:336-993-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006049Medicaid