| Envision Behavioral Health Pllc | |
|
2554 Lewisville Clemmons Rd Ste 207 Clemmons NC 27012-9752 | |
| (304) 617-4337 | |
| (339) 207-0143 |
| Full Name | Envision Behavioral Health Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2554 Lewisville Clemmons Rd Ste 207, Clemmons, North Carolina |
| Authorized Official Name and Position | Jessica Cipoletti Derreberry (MANAGING MEMBER) |
| Authorized Official Contact | 3046174337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Envision Behavioral Health Pllc 100 Stadium Oaks Dr Ste B Clemmons NC 27012-8961 Ph: () - | Envision Behavioral Health Pllc 2554 Lewisville Clemmons Rd Ste 207 Clemmons NC 27012-9752 Ph: (304) 617-4337 |
| NPI Number | 1689165508 |
|---|---|
| Provider Enumeration Date | 05/25/2018 |
| Last Update Date | 06/10/2020 |
| Certification Date | 06/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689165508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 2016-01870 (North Carolina) | Primary |
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