Healthcare Provider Details

I. General information

NPI: 1992529234
Provider Name (Legal Business Name): THERAPY COLLAB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SALEM TOWNE CT UNIT B
APEX NC
27502-2311
US

IV. Provider business mailing address

1939 NAPOLI DR
APEX NC
27502-9662
US

V. Phone/Fax

Practice location:
  • Phone: 804-814-7970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HOLLY RUSSELL
Title or Position: OWNER
Credential: LMFT
Phone: 804-814-7970