Provider Demographics
NPI:1851626113
Name:WINNERS CIRCLE GROUP, LLC
Entity Type:Organization
Organization Name:WINNERS CIRCLE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:919-934-1266
Mailing Address - Street 1:1317 N BRIGHTLEAF BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-7267
Mailing Address - Country:US
Mailing Address - Phone:919-934-1266
Mailing Address - Fax:919-934-2918
Practice Address - Street 1:1317 N BRIGHTLEAF BLVD STE A
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7267
Practice Address - Country:US
Practice Address - Phone:919-934-1266
Practice Address - Fax:919-934-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health