Provider Demographics
NPI:1578819934
Name:A HERO'S JOURNEY, INC.
Entity type:Organization
Organization Name:A HERO'S JOURNEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCAS(P), CSAPC
Authorized Official - Phone:336-772-3040
Mailing Address - Street 1:810 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1813
Mailing Address - Country:US
Mailing Address - Phone:336-772-3040
Mailing Address - Fax:
Practice Address - Street 1:810 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1813
Practice Address - Country:US
Practice Address - Phone:336-772-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health