Organization
CHANGING PHASES BEHAVIORAL SUPPORT
Active
Other names
Changing Phases Behavioral Support One
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUINTEN CULLINS (PROGRAM DIRECTOR)
(336) 333-2542
Entity
Organization
Contact information
Practice address
1609 CLEMMONS ST, GREENSBORO, NC 27406-2870
(336) 333-2542
(336) 333-2858
Mailing address
338 N ELM ST, SUITE 215, GREENSBORO, NC 27401-2177
(336) 333-2542
(336) 333-2858
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-794
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-041-894
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006908
—
NC
05
—
6604413
—
NC
05
—
8301765
—
NC
05
—
8301765G
—
NC
Enumeration date
12/11/2006
Last updated
03/12/2012
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