Healthcare Provider Details

I. General information

NPI: 1700028008
Provider Name (Legal Business Name): ABERDIUM5, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 OLD FAYETTEVILLE RD D202
CARRBORO NC
27510-5506
US

IV. Provider business mailing address

222 OLD FAYETTEVILLE RD D-202
CARRBORO NC
27510-5503
US

V. Phone/Fax

Practice location:
  • Phone: 919-357-8305
  • Fax:
Mailing address:
  • Phone: 919-357-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBARN DANZMAN
Title or Position: OWNER
Credential: M.S.
Phone: 919-357-8305