Provider Demographics
NPI:1801413687
Name:MILLENNIAL SERVICES OF NC AT ROCKINGHAM
Entity Type:Organization
Organization Name:MILLENNIAL SERVICES OF NC AT ROCKINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, PHD, ICADC, NCAC
Authorized Official - Phone:336-587-2931
Mailing Address - Street 1:1520 BOWMORE PL
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9248
Mailing Address - Country:US
Mailing Address - Phone:033-658-7293
Mailing Address - Fax:
Practice Address - Street 1:510 S TIPTON PL
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3039
Practice Address - Country:US
Practice Address - Phone:336-587-2931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLENNIAL SERVICES OF NC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty