Provider Demographics
NPI:1821393984
Name:TWO DREAMS
Entity Type:Organization
Organization Name:TWO DREAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:877-355-3732
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:COROLLA
Mailing Address - State:NC
Mailing Address - Zip Code:27927-0635
Mailing Address - Country:US
Mailing Address - Phone:877-355-3732
Mailing Address - Fax:
Practice Address - Street 1:1150 PERSIMON STREET
Practice Address - Street 2:
Practice Address - City:COROLLA
Practice Address - State:NC
Practice Address - Zip Code:27927
Practice Address - Country:US
Practice Address - Phone:877-355-3732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-027-010251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health