Organization
LSBF PROFESSIONAL COUNSELING SERVICES, PLLC
Active
Other names
Ellie Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYANT FORIEST (DIRECTOR OF MARKETING AND OUTREACH)
(336) 266-3289
Entity
Organization
Contact information
Practice address
250 EXECUTIVE PARK BLVD STE 120, WINSTON SALEM, NC 27103-1534
(336) 266-3289
Mailing address
8575 SHEPPARDS RUN DR, KERNERSVILLE, NC 27284-7395
(336) 266-3289
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/21/2023
Last updated
10/16/2023
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