Healthcare Provider Details

I. General information

NPI: 1033585187
Provider Name (Legal Business Name): SMILING SPIRIT PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SALEM ST
APEX NC
27502-1824
US

IV. Provider business mailing address

207 S SALEM ST
APEX NC
27502-1824
US

V. Phone/Fax

Practice location:
  • Phone: 919-606-2547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC003986
License Number StateNC

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. CHERIE L SPEHAR
Title or Position: OWNER
Credential: LCSW
Phone: 919-606-2547