Healthcare Provider Details

I. General information

NPI: 1205734548
Provider Name (Legal Business Name): ROAD SONG THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2026
Last Update Date: 10/27/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BROADWAY ST STE 502
DURHAM NC
27701-2402
US

IV. Provider business mailing address

112 BROADWAY ST STE 502
DURHAM NC
27701-2402
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-8117
  • Fax: 505-633-3014
Mailing address:
  • Phone: 919-627-8117
  • Fax: 505-633-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PAUL ROBERT WARREN
Title or Position: OWNER
Credential: LCSW
Phone: 919-627-8117