NPIMap

Organization Active NPI

Myriad Support Center

  • Mental Health Counselor
  • Winston Salem, NC
National Provider Identifier
1790097525
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MYRIAD SUPPORT CENTER
Practice address
3540 Vest Mill Rd Ste 6
Winston Salem, NC 27103-2988
Phone
(336) 602-2940
NPI assigned
Jul 9, 2010
Last updated
Jul 9, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
SURRENT CAPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Yussef Lateef Gilkey
Title
Ceo
Phone
(336) 575-2002

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

3540 Vest Mill Rd Ste 6
Winston Salem, NC 27103-2988

Mailing address

3540 Vest Mill Rd Ste 6
Winston Salem, NC 27103-2988

National Provider Directory

National Provider Directory
Tax ID family
Myriad Support Center5 organizations share this tax ID, including this one
Part of
Myriad Support Center

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1790097525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 VEST MILL RD STE 6",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 VEST MILL RD STE 6",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032988",
            "telephone_number": "336-602-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRIAD SUPPORT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SURRENT CAPITAL, INC",
        "enumeration_date": "2010-07-09",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "GILKEY",
        "authorized_official_first_name": "YUSSEF",
        "authorized_official_middle_name": "LATEEF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-575-2002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.