1598237687 NPI number — PROVEN PROGRESS COUNSELING AND TRAUMA TREATMENT PLLC

Table of content: (NPI 1598237687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598237687 NPI number — PROVEN PROGRESS COUNSELING AND TRAUMA TREATMENT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVEN PROGRESS COUNSELING AND TRAUMA TREATMENT PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598237687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9650 STRICKLAND RD STE 103-416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-276-0626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 LAKE BOONE TRL STE 2D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-7503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-276-0626
Provider Business Practice Location Address Fax Number:
844-355-2247
Provider Enumeration Date:
12/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DUFFY-GILL
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
919-276-0626

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1356664304 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com