Provider Demographics
NPI:1588696330
Name:OPTIONS OF WINSTON SALEM
Entity type:Organization
Organization Name:OPTIONS OF WINSTON SALEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:336-768-9768
Mailing Address - Street 1:3000 BETHESDA PLACE
Mailing Address - Street 2:STE 103
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3323
Mailing Address - Country:US
Mailing Address - Phone:336-768-9768
Mailing Address - Fax:336-768-9557
Practice Address - Street 1:3000 BETHESDA PLACE
Practice Address - Street 2:STE 103
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3323
Practice Address - Country:US
Practice Address - Phone:336-768-9768
Practice Address - Fax:336-768-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)