Provider Demographics
NPI:1760671754
Name:ROCKINGHAM FAMILY HEALTH, PSYCHOLOGICAL & COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:ROCKINGHAM FAMILY HEALTH, PSYCHOLOGICAL & COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CNS-PSYCHIA
Authorized Official - Phone:336-349-7855
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-0719
Mailing Address - Country:US
Mailing Address - Phone:336-349-7855
Mailing Address - Fax:336-349-3329
Practice Address - Street 1:1701 S SCALES ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5638
Practice Address - Country:US
Practice Address - Phone:336-349-7855
Practice Address - Fax:336-349-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC092384261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health