Organization
STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETICIA ESTELA HELLEBY-HARDY M.D. (DIRECTOR)
(336) 765-8614
Entity
Organization
Contact information
Practice address
3410 HEALY DR, SUITE 110, WINSTON SALEM, NC 27103-1403
(336) 765-8614
(336) 765-8605
Mailing address
PO BOX 843, CROZET, VA 22932-0801
(336) 765-8614
(336) 765-8605
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NC
208000000X
Pediatrics Physician
Primary
177279
NC
363LF0000X
Family Nurse Practitioner
124938
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026MP
BCBS
—
Enumeration date
11/28/2011
Last updated
04/26/2016
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