Provider Demographics
NPI:1205523917
Name:IMPACT4TODAY, PLLC
Entity type:Organization
Organization Name:IMPACT4TODAY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAIL
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCAS, LCMHC, CHT
Authorized Official - Phone:336-329-8506
Mailing Address - Street 1:822 N ELM ST STE 109
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1538
Mailing Address - Country:US
Mailing Address - Phone:336-329-8506
Mailing Address - Fax:336-510-4434
Practice Address - Street 1:822 N ELM ST STE 109
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1538
Practice Address - Country:US
Practice Address - Phone:336-329-8506
Practice Address - Fax:336-510-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)