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Organization
NEW-LITE LIVING CHOICES TUNSTALL MARVIN GEN PTR
Active
Organization
NEW-LITE LIVING CHOICES TUNSTALL MARVIN GEN PTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE FOLTZ CAHOON (BILLING SPECIALIST)
(704) 906-8893
Entity
Organization
Contact information
Practice address
3634 VEST MILL RD, WINSTON SALEM, NC 27103-2910
(704) 547-1900
Mailing address
416 MCCULLOUGH DR, SUITE 125, CHARLOTTE, NC 28262-4385
(704) 547-1900
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
8300407
NC
251B00000X
Case Management Agency
8300407
NC
251S00000X
Community/Behavioral Health Agency
Primary
8300407
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
6603599
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
6603600
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
6603994
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
6604265
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300407
—
NC
05
—
8300407G
—
NC
05
—
8300407H
—
NC
Enumeration date
02/22/2007
Last updated
02/03/2009
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