Provider Demographics
NPI:1821610205
Name:WINNERS CIRCLE GROUP OF TX
Entity Type:Organization
Organization Name:WINNERS CIRCLE GROUP OF TX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-904-6187
Mailing Address - Street 1:9962 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6501
Mailing Address - Country:US
Mailing Address - Phone:704-904-6187
Mailing Address - Fax:
Practice Address - Street 1:4405 N GARFIELD STREET
Practice Address - Street 2:APT. 1005
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:704-904-6187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health