Organization
A LEGACY FAFILLED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND HORNE (OWNER)
(336) 383-7414
Entity
Organization
Contact information
Practice address
3712 MIZELL RD APT F, GREENSBORO, NC 27405-4717
(336) 383-7414
Mailing address
3712 MIZELL RD APT F, GREENSBORO, NC 27405-4717
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/06/2015
Last updated
03/06/2015
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