Healthcare Provider Details

I. General information

NPI: 1053235689
Provider Name (Legal Business Name): SET APART MENTAL HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 NEWPORT CT
NASHVILLE NC
27856-3303
US

IV. Provider business mailing address

1444 JEFFREYS RD # 118
ROCKY MOUNT NC
27804-1820
US

V. Phone/Fax

Practice location:
  • Phone: 215-290-6428
  • Fax:
Mailing address:
  • Phone: 215-290-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PANYA HENRY
Title or Position: OWNER/PSYCHIATRIC/MEDICAL PROVIDER
Credential: PMHNP, AGNP
Phone: 215-290-6428