Contact Us - Children's Center of Northwest North Carolina

Referring Agency or Referring Individual Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Client Name
First Last
Date of Birth
Medicaid Number*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Legal Guardian
Your relationship to client
Previous or Current Mental Health Diagnosis (if any)
Previous Counseling and Reason
Name of Counseling Agency
Year(s) Attended
Reason for Referral
Guardian Contact Number

520 North Main Street
PO Box 692
Dobson, North Carolina 27017

Phone: 336-386-9144
Fax: 336-386-9147

117 South Jackson Street
Yadkinville, North Carolina 27055

Phone: 336-849-4007
Fax: 336-386-9147

151 Jefferson Church Road
King, North Carolina 27021

Phone: 336-983-4026
Fax: 336-985-3302

910 C Street
North Wilkesboro, North Carolina 28659

Phone: 336-990-9222

626 Ashe Central School Road #106
Jefferson, North Carolina 28640

Phone: 336-982-4100

115 Atwood Street, Suite 205
Sparta, NC 28675

Phone: 336-469-5063