Healthcare Provider Details

I. General information

NPI: 1346972825
Provider Name (Legal Business Name): CARRY YOUR HEART THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PINE MILL LN
APEX NC
27502-9501
US

IV. Provider business mailing address

103 PINE MILL LN
APEX NC
27502-9501
US

V. Phone/Fax

Practice location:
  • Phone: 919-576-6412
  • Fax: 984-333-9188
Mailing address:
  • Phone: 919-576-6412
  • Fax: 984-333-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
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: MS. BETH MANNS
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSWA
Phone: 919-576-6412