Healthcare Provider Details

I. General information

NPI: 1679486831
Provider Name (Legal Business Name): JOURNEY WITHIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENSINGTON DR APT 806
JACKSONVILLE NC
28546-7153
US

IV. Provider business mailing address

800 KENSINGTON DR APT 806
JACKSONVILLE NC
28546-7153
US

V. Phone/Fax

Practice location:
  • Phone: 929-405-4844
  • Fax:
Mailing address:
  • Phone: 929-405-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIELLE JULIA SILLS
Title or Position: LICENSED CLINICAL ADDICTION SPECIAL
Credential: LCAS-A
Phone: 929-405-4844