Organization
MID ATLANTIC DEVELOPMENT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATISSE WITHERSPOON (CEO)
(336) 448-8927
Entity
Organization
Contact information
Practice address
625 PINEY FOREST RD, DANVILLE, VA 24540-2867
(336) 448-8927
Mailing address
2071 BETHANY TRACE LN, WINSTON SALEM, NC 27127-6843
(336) 448-8927
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/01/2017
Last updated
11/01/2017
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