Healthcare Provider Details

I. General information

NPI: 1316865058
Provider Name (Legal Business Name): DAWNSHANAECO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 NOVA ST
DURHAM NC
27713-4526
US

IV. Provider business mailing address

1107 NOVA ST
DURHAM NC
27713-4526
US

V. Phone/Fax

Practice location:
  • Phone: 839-214-5944
  • Fax: 839-214-5944
Mailing address:
  • Phone: 839-214-5944
  • Fax: 839-214-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN PRIVETTE
Title or Position: OWNER
Credential:
Phone: 839-214-5944