Healthcare Provider Details

I. General information

NPI: 1871756411
Provider Name (Legal Business Name): MEDICAL HYPNOSIS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 UNIVERSITY DR STE A
DURHAM NC
27707-6231
US

IV. Provider business mailing address

3721 UNIVERSITY DR STE A
DURHAM NC
27707-6231
US

V. Phone/Fax

Practice location:
  • Phone: 919-403-7229
  • Fax:
Mailing address:
  • Phone: 919-403-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. HOLLY FORESTER-MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 919-403-7229