MEDICARE: DEETOX PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1588504120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEETOX PLLC

Provider Business Mailing Address
First Line	:	3057 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5154
Country	:	US
Telephone Number	:	336-214-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 S CHURCH ST
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5154
Country	:	US
Telephone Number	:	336-214-0008
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, OWNER, MEDICAL DIRECTOR
Name	:	DR. HELEN POWELL BODE
Credential	:	MD
Telephone Number	:	336-214-0008

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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Directions to “DEETOX PLLC ” Practice Location

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