Provider Demographics
NPI:1932154408
Name:BEHAVIORAL ASSOCIATES OF ASHEBORO
Entity Type:Organization
Organization Name:BEHAVIORAL ASSOCIATES OF ASHEBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-7112
Mailing Address - Street 1:547 N. FAYETTEVILLIE STREET
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204
Mailing Address - Country:US
Mailing Address - Phone:336-629-7112
Mailing Address - Fax:336-629-0312
Practice Address - Street 1:547 N. FAYETTEVILLIE STREET
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205
Practice Address - Country:US
Practice Address - Phone:336-629-7112
Practice Address - Fax:336-629-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111760Medicaid