Provider Demographics
NPI:1831273440
Name:THE WORKSHOP OF DAVIDSON, INC.
Entity type:Organization
Organization Name:THE WORKSHOP OF DAVIDSON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARROL
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-248-2816
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0906
Mailing Address - Country:US
Mailing Address - Phone:336-248-2816
Mailing Address - Fax:336-248-4995
Practice Address - Street 1:275 MONROE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-9707
Practice Address - Country:US
Practice Address - Phone:336-248-2816
Practice Address - Fax:336-248-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
NCMHL-029-024320600000X
NCMHL-029-025320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities