Basic Information
| Provider Information | |||||||||
| NPI: | 1417156241 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARTNERSHIP FOR A DRUG FREE NC, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INSIGHT HUMAN SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271012701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367258389 | ||||||||
| FaxNumber: | 3367256628 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048544196 | ||||||||
| FaxNumber: | 7048544200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | MATKINS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3367258389 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.