Healthcare Provider Details

I. General information

NPI: 1285561910
Provider Name (Legal Business Name): FREDA BANTHER DIAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EDINBURGH SOUTH DR STE 100
CARY NC
27511-7902
US

IV. Provider business mailing address

130 EDINBURGH SOUTH DR STE 100
CARY NC
27511-7902
US

V. Phone/Fax

Practice location:
  • Phone: 919-462-8308
  • Fax: 919-462-0433
Mailing address:
  • Phone: 919-323-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004196
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: