Provider Demographics
NPI:1073308151
Name:WINGS OF A BUTTERFLY PSYCHOSOCIAL REHAB CENTER
Entity type:Organization
Organization Name:WINGS OF A BUTTERFLY PSYCHOSOCIAL REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:252-343-5246
Mailing Address - Street 1:4246 WESTERLY CT
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-8789
Mailing Address - Country:US
Mailing Address - Phone:252-343-5246
Mailing Address - Fax:
Practice Address - Street 1:4246 WESTERLY CT
Practice Address - Street 2:
Practice Address - City:ELM CITY
Practice Address - State:NC
Practice Address - Zip Code:27822-8789
Practice Address - Country:US
Practice Address - Phone:252-343-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health