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Organization

LYFES NEW DIRECTION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JUDITH A BAGLEY (ORGANIZER)
(336) 721-4261
Entity
Organization

Contact information

Practice address
1001 S MARSHALL ST # 65, WINSTON SALEM, NC 27101-5852
(336) 721-4261
(336) 721-4265
Mailing address
1001 S MARSHALL ST # 65, WINSTON SALEM, NC 27101-5852
(336) 721-4261
(336) 721-4265

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
C2009212000082
NC

Other

Enumeration date
08/28/2009
Last updated
08/28/2009
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