Healthcare Provider Details

I. General information

NPI: 1073793865
Provider Name (Legal Business Name): REDIRECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 ENGLERT DR STE 206 2327 ENGLERT DRIVE STE 206
DURHAM NC
27713-4449
US

IV. Provider business mailing address

2327 ENGLERT DR STE 206 2327 ENGLERT DRIVE STE 206
DURHAM NC
27713-4449
US

V. Phone/Fax

Practice location:
  • Phone: 919-484-4134
  • Fax: 919-484-1812
Mailing address:
  • Phone: 919-484-4134
  • Fax: 919-484-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TANYA DANIELLA MELTON
Title or Position: CEO
Credential:
Phone: 919-641-5722