Healthcare Provider Details

I. General information

NPI: 1649154881
Provider Name (Legal Business Name): GOLDEN HEART WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E ALTON ST
DURHAM NC
27707-3005
US

IV. Provider business mailing address

314 E ALTON ST
DURHAM NC
27707-3005
US

V. Phone/Fax

Practice location:
  • Phone: 919-298-9322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY RAWLS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 919-593-4407