Healthcare Provider Details

I. General information

NPI: 1487035911
Provider Name (Legal Business Name): CELEBRITY THERAPEUTIC SERVICES,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 EMPEROR BLVD SUITE 400
DURHAM NC
27703-5420
US

IV. Provider business mailing address

4819 EMPEROR BLVD SUITE 400
DURHAM NC
27703-5420
US

V. Phone/Fax

Practice location:
  • Phone: 301-455-3415
  • Fax:
Mailing address:
  • Phone: 301-455-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number333976
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21143
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8967
License Number StateNC

VIII. Authorized Official

Name: DANA ROBINSON
Title or Position: OWNER/ORGANIZER
Credential: LPC, NCC, LCAS-A,
Phone: 301-455-3415