34D0983708 CLIA NUMBER - OLD VINEYARD BEHAVIORAL HEALTH SERVICES

Laboratory Demographics

  • CLIA Code: 34D0983708
  • Facility Name: OLD VINEYARD BEHAVIORAL HEALTH SERVICES
  • Facility Address: 3637 OLD VINEYARD RD
    WINSTON-SALEM, NC
    ZIP 27104
  • Facility Phone: 336 794-3546
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: KELLY THACKER
  • NPI Number: 1780817452
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 34D0983708
LAB Type Other
Facility Name OLD VINEYARD BEHAVIORAL HEALTH SERVICES
Street 3637 OLD VINEYARD RD
City WINSTON-SALEM
State NC
ZIP 27104
Phone 336 794-3546
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Other
Lab Director KELLY THACKER

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This page was last updated on: 9/29/2025