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Organization
CHANGING PHASES BEHAVIORAL SUPPORT
Active
Organization
CHANGING PHASES BEHAVIORAL SUPPORT
Active
Other names
Changing Phases Behavioral Support One
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUINTEN CULLINS (PROGRAM DIRECTOR)
(336) 333-2542
Entity
Organization
Contact information
Practice address
1609 CLEMMONS ST, GREENSBORO, NC 27406-2870
(336) 333-2542
(336) 333-2858
Mailing address
338 N ELM ST, SUITE 215, GREENSBORO, NC 27401-2177
(336) 333-2542
(336) 333-2858
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-794
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-041-894
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006908
—
NC
05
—
6604413
—
NC
05
—
8301765
—
NC
05
—
8301765G
—
NC
Enumeration date
12/11/2006
Last updated
03/12/2012
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