Healthcare Provider Details

I. General information

NPI: 1407240047
Provider Name (Legal Business Name): INTOUCH OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 SKYBROOK LN
DURHAM NC
27703-5978
US

IV. Provider business mailing address

PO BOX 3619
CHAPEL HILL NC
27515-3619
US

V. Phone/Fax

Practice location:
  • Phone: 919-904-2966
  • Fax: 888-965-9951
Mailing address:
  • Phone: 919-904-2966
  • Fax: 888-965-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9700466
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9700466
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number9700466
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number9700466
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number9700466
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9700466
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number9700466
License Number StateNC
# 9
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9700466
License Number StateNC

VIII. Authorized Official

Name: LAVETTA BOLDIN
Title or Position: CEO/OWNER
Credential:
Phone: 919-904-2966