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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SIGNAL WHITE (ADMINISTRATOR)
(336) 350-0389
Entity
Organization

Contact information

Practice address
1146 N CHURCH ST, SUITE F, BURLINGTON, NC 27217-2702
(336) 350-0389
(336) 222-5998
Mailing address
341 SHARPE RD, BURLINGTON, NC 27217-8648
(336) 350-0389
(336) 222-5998

Taxonomy

Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
MHL-001-160
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
MHL-001-160
NC
Enumeration date
06/29/2008
Last updated
06/29/2008
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