STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER (NPI# 1801163423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801163423 |
| Entity Type | Organization |
| Organization Name | STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER |
| Practice Address |
3410 Healy Dr Suite 110 Winston Salem NC 27103-1403 |
| Mailing Address |
Po Box 843 Crozet VA 22932-0801 |
| Practice Telephone | 3367658614 |
| Practice Fax Number | 3367658605 |
| Mailing Telephone | 3367658614 |
| Mailing Fax Number | 3367658605 |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2016-04-26 |
| Authorized Official Name | LETICIA ESTELA HELLEBY-HARDY (DIRECTOR) |
| Authorized Official Telephone | 3367658614 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
NC | Behavioral Health & Social Service Providers | |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
124938 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 208000000X | Pediatrics | 177279 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | 026MP | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER | 3410 Healy Dr, Winston Salem, NC 27103-1403 |
| Street Address |
3410 HEALY DR SUITE 110 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-1403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578549853 | Sean Patrick Nelligan | Social Worker | 3410 Healy Dr, Ste. 202, Winston Salem, NC 27103-1403 | 2005-12-19 |
| 1407367246 | John Daniel Erwin | Massage Therapist | 3410 Healy Dr, Ste 201-a, Winston Salem, NC 27103-1568 | 2017-10-19 |
| 1245694702 | Robin E Dock Phd | Community/Behavioral Health | 3410 Healy Dr, Suite 203, Winston Salem, NC 27103-1403 | 2016-04-11 |
| 1649630997 | New Life Counseling Center, Pllc | Counselor | 3410 Healy Dr, Suite 207, Winston Salem, NC 27103-1403 | 2016-02-29 |
| 1154718278 | Mission Medstaff, LLC | Nursing Care | 3410 Healy Dr, Suite 102, Winston Salem, NC 27103-1403 | 2015-04-16 |
| 1194117739 | Graham Counseling & Associates, LLC | Community/Behavioral Health | 3410 Healy Dr, Suite 117, Winston Salem, NC 27103-1403 | 2015-02-18 |
| 1578986717 | Footprints Counseling, Pllc | Marriage & Family Therapist | 3410 Healy Dr, Suite 200-a, Winston Salem, NC 27103-1403 | 2014-01-23 |
| 1144652090 | Healthcore Resource, Inc | Community/Behavioral Health | 3410 Healy Dr, Suite 201, Winston Salem, NC 27103-1403 | 2013-08-02 |
| 1013268051 | Reaching Your Goals | Community/Behavioral Health | 3410 Healy Dr, Winston Salem, NC 27103-1403 | 2012-10-01 |
| 1699044321 | Healthcore Reaource | Community/Behavioral Health | 3410 Healy Dr, Ste 201, Winston Salem, NC 27103-1403 | 2011-12-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609223601 | Ashmitha Raja | Pediatrics | Medical Centre Blvd, Winston Salem, NC 27157-0001 | 2016-05-19 |
| 1598128050 | Rebecca Palmer | Pediatrics | Brenner Childrens Hospital 300 Medical Blvd, Dept of Pediatrics, Winston Salem, NC 27157-0001 | 2016-04-01 |
| 1396131157 | Sarah Barnes Bingham | Pediatrics | One Medical Center Boulevard Emergency Medicine, Winston Salem, NC 27157 | 2015-04-08 |
| 1841685849 | Anna Hang Verenes | Pediatrics | Wake Forest Baptist Health Pediatrics, Medical Center Blvd, Winston Salem, NC 27157 | 2015-04-06 |
| 1568875227 | Kimberly Myers | Pediatrics | Wake Forest Baptist Medical, Medical Center Blvd, Winston Salem, NC 27157-0001 | 2014-06-10 |
| 1760700736 | Jennifer Mickle Cooper | Pediatrics | 2295 E 14th St Ste 100, Winston Salem, NC 27105-6804 | 2010-05-14 |
| 1215179700 | Cyndy Edwards Lively | Pediatrics | 1417 Brookstown Ave, Winston Salem, NC 27101-1126 | 2009-03-30 |
| 1205003274 | Bahar Emily Esmaili | Pediatrics | Wake Forest University Baptist Hospital, Medical Center Blvd, Winston Salem, NC 27157-0001 | 2008-05-09 |
| 1922274240 | Mdfamily Medical Group | Pediatrics | 138 S Cherry St, Winston Salem, NC 27101-5272 | 2008-05-06 |
| 1083714364 | Lia Simpson Erickson | Pediatrics | 648 East Monmouth Street, Winston Salem, NC 27107 | 2006-09-25 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
Please comment or provide details below to improve the information on STEP UP PEDIATRIC AND ADOLESCENT WELLNESS CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.