Healthcare Provider Details

I. General information

NPI: 1861069080
Provider Name (Legal Business Name): MORSE CLINIC OF DURHAM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 CAPITOL ST
DURHAM NC
27704-2153
US

IV. Provider business mailing address

4119 CAPITOL ST
DURHAM NC
27704-2153
US

V. Phone/Fax

Practice location:
  • Phone: 919-294-9621
  • Fax: 919-294-9794
Mailing address:
  • Phone: 919-294-9621
  • Fax: 919-294-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA MICHELLE KORNEGAY
Title or Position: CEO
Credential: LCAS
Phone: 919-294-9621