Provider Demographics
NPI:1992938120
Name:POSITIVE INNOVATED BEGINNINGS, LLC
Entity type:Organization
Organization Name:POSITIVE INNOVATED BEGINNINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATRICIA
Authorized Official - Middle Name:TANKSLEY
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:336-602-9597
Mailing Address - Street 1:220 PARK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3840
Mailing Address - Country:US
Mailing Address - Phone:336-602-9597
Mailing Address - Fax:
Practice Address - Street 1:1001 S MARSHALL ST
Practice Address - Street 2:SUITE 2-6
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-602-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health