Healthcare Provider Details

I. General information

NPI: 1629851605
Provider Name (Legal Business Name): PAINTING MIRACLES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 FORT BRAGG RD STE 200
FAYETTEVILLE NC
28305-4982
US

IV. Provider business mailing address

1248 FORT BRAGG RD STE 200
FAYETTEVILLE NC
28305-4982
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-2121
  • Fax: 910-229-3331
Mailing address:
  • Phone: 910-339-2121
  • Fax: 910-229-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARMELITA TIBURCIO BIGELOW
Title or Position: PSYCHOLOGIST/CEO
Credential: PHD
Phone: 910-777-4887