Provider Demographics
NPI:1700954773
Name:NEW HOPE CENTER OF WINSTON-SALEM, LLC
Entity Type:Organization
Organization Name:NEW HOPE CENTER OF WINSTON-SALEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:336-765-3586
Mailing Address - Street 1:3314 HEALY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1408
Mailing Address - Country:US
Mailing Address - Phone:336-765-3586
Mailing Address - Fax:336-774-2109
Practice Address - Street 1:3314 HEALY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1408
Practice Address - Country:US
Practice Address - Phone:336-765-3586
Practice Address - Fax:336-774-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0005991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty