Healthcare Provider Details

I. General information

NPI: 1477387629
Provider Name (Legal Business Name): FOOD HUT UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 WICKHAM CT
CLEMMONS NC
27012-7573
US

IV. Provider business mailing address

219 WICKHAM CT
CLEMMONS NC
27012-7573
US

V. Phone/Fax

Practice location:
  • Phone: 917-435-7170
  • Fax:
Mailing address:
  • Phone:
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: VICTOR FORTUNE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 917-435-7170