Healthcare Provider Details

I. General information

NPI: 1346039898
Provider Name (Legal Business Name): MOTIVATE & MAINTAIN CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 MISSION BAY BLVD APT 254
ORLANDO FL
32817-5112
US

IV. Provider business mailing address

357 OLD HOLLOW RD STE 4
WINSTON SALEM NC
27105-9684
US

V. Phone/Fax

Practice location:
  • Phone: 336-491-9006
  • Fax:
Mailing address:
  • Phone: 336-491-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONTRAVON HERBIN
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 336-491-9906