| Dynasty Diverse Services, Llc | |
|
211 Julian Pond Ln Kernersville NC 27284-2461 | |
| (336) 462-7275 | |
| Not Available |
| Full Name | Dynasty Diverse Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 211 Julian Pond Ln, Kernersville, North Carolina |
| Authorized Official Name and Position | Thomina Mcnair-mills (MANAGING MEMBER) |
| Authorized Official Contact | 3364627275 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynasty Diverse Services, Llc 211 Julian Pond Ln Kernersville NC 27284-2461 Ph: (336) 462-7275 | Dynasty Diverse Services, Llc 211 Julian Pond Ln Kernersville NC 27284-2461 Ph: (336) 462-7275 |
| NPI Number | 1356584023 |
|---|---|
| Provider Enumeration Date | 04/10/2009 |
| Last Update Date | 03/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356584023 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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