Healthcare Provider Details

I. General information

NPI: 1356711170
Provider Name (Legal Business Name): THE FREEDOM TO SHINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N MAIN ST
FRANKLINTON NC
27525-1357
US

IV. Provider business mailing address

2 N MAIN ST
FRANKLINTON NC
27525-1357
US

V. Phone/Fax

Practice location:
  • Phone: 954-560-5238
  • Fax: 888-510-9071
Mailing address:
  • Phone: 954-560-5238
  • Fax: 888-510-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1912
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP006302
License Number StateNC

VIII. Authorized Official

Name: DENISE Y MELENDEZ
Title or Position: BILLING DIRECTOR
Credential: CEO
Phone: 954-560-5238