Healthcare Provider Details

I. General information

NPI: 1003793118
Provider Name (Legal Business Name): INNERBALANCE DIAGNOSIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 KILMAYNE DR STE 201
CARY NC
27511-4491
US

IV. Provider business mailing address

330 EUPHORIA CIR
CARY NC
27519-5547
US

V. Phone/Fax

Practice location:
  • Phone: 919-576-2607
  • Fax: 919-935-0858
Mailing address:
  • Phone: 917-581-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHIRLEYJO LEE
Title or Position: OWNER
Credential:
Phone: 919-576-2607