Organization
WTB NEW VISION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN HAIRSTON (EXECUTIVE DIRECTOR)
(336) 723-7707
Entity
Organization
Contact information
Practice address
102 W 3RD ST, SUITE 502, WINSTON SALEM, NC 27101-3940
(336) 723-7707
(336) 723-7708
Mailing address
102 W 3RD ST, SUITE 502, WINSTON SALEM, NC 27101-3987
(336) 723-7707
(336) 723-7708
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-034-170
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-034-185
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603536
—
NC
05
—
6603924
—
NC
05
—
6604170
—
NC
05
—
8300791
—
NC
05
—
8300791B
—
NC
05
—
8300791G
—
NC
Enumeration date
11/02/2006
Last updated
06/06/2014
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