Healthcare Provider Details

I. General information

NPI: 1871060160
Provider Name (Legal Business Name): DEPTHWORKS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PAVERSTONE DR STE 9
RALEIGH NC
27615-4708
US

IV. Provider business mailing address

901 PAVERSTONE DR STE 9
RALEIGH NC
27615-4708
US

V. Phone/Fax

Practice location:
  • Phone: 919-623-8118
  • Fax:
Mailing address:
  • Phone: 919-623-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY ANDREW DELMEDICO
Title or Position: MEMBER/MANAGER
Credential: LMFT
Phone: 919-623-8118