Healthcare Provider Details

I. General information

NPI: 1144155292
Provider Name (Legal Business Name): 41 RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 HESTER ROAD
CREEDMOOR NC
27522
US

IV. Provider business mailing address

5540 CENTERVIEW DR STE 204
RALEIGH NC
27606-8012
US

V. Phone/Fax

Practice location:
  • Phone: 919-691-2623
  • Fax:
Mailing address:
  • Phone: 919-691-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: AMY J CLOUGH
Title or Position: OWNER/CPSS
Credential:
Phone: 919-691-3623