Provider Demographics
NPI:1609464726
Name:WESTGATE COUNSELING & WELLNESS
Entity type:Organization
Organization Name:WESTGATE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ZORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LCAS, EDS
Authorized Official - Phone:704-682-1139
Mailing Address - Street 1:PO BOX 26342
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-6342
Mailing Address - Country:US
Mailing Address - Phone:336-283-7070
Mailing Address - Fax:
Practice Address - Street 1:1319 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2918
Practice Address - Country:US
Practice Address - Phone:336-283-7070
Practice Address - Fax:336-659-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)