Provider Demographics
NPI:1831138296
Name:PRESBYTERIAN COUNSELING CENTER OF GREENSBORO, INC
Entity Type:Organization
Organization Name:PRESBYTERIAN COUNSELING CENTER OF GREENSBORO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-288-1484
Mailing Address - Street 1:3713 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2111
Mailing Address - Country:US
Mailing Address - Phone:336-288-1484
Mailing Address - Fax:336-288-0738
Practice Address - Street 1:3713 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2111
Practice Address - Country:US
Practice Address - Phone:336-288-1484
Practice Address - Fax:336-288-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2018-07-19
Deactivation Date:2018-01-08
Deactivation Code:
Reactivation Date:2018-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2873440Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER