Healthcare Provider Details

I. General information

NPI: 1679417984
Provider Name (Legal Business Name): TAKIA SHARI WEEKS-HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11591 CLAUDE LEWIS RD
MIDDLESEX NC
27557-7809
US

IV. Provider business mailing address

11591 CLAUDE LEWIS RD
MIDDLESEX NC
27557-7809
US

V. Phone/Fax

Practice location:
  • Phone: 919-780-9508
  • Fax:
Mailing address:
  • Phone: 919-780-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: