Healthcare Provider Details

I. General information

NPI: 1053868521
Provider Name (Legal Business Name): RWA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11470 US 15-501 HWY N
CHAPEL HILL NC
27517
US

IV. Provider business mailing address

1000 PARK FORTY PLZ STE 470
DURHAM NC
27713-5259
US

V. Phone/Fax

Practice location:
  • Phone: 919-928-2297
  • Fax:
Mailing address:
  • Phone: 919-928-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TISHANNA FIELDS
Title or Position: OWNER/ OPERATOR
Credential:
Phone: 919-928-2297