Healthcare Provider Details

I. General information

NPI: 1487975074
Provider Name (Legal Business Name): COTTAGE HEALTH CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3826 BLAND RD STE 200
RALEIGH NC
27609-6239
US

IV. Provider business mailing address

3826 BLAND RD
RALEIGH NC
27609-6239
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-1441
  • Fax: 919-872-1455
Mailing address:
  • Phone: 919-872-1441
  • Fax: 919-872-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMHI-092-777
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberMHI-092-777
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberMHI-092-777
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHI-092-777
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMHI-092-777
License Number StateNC

VIII. Authorized Official

Name: MR. OBIORAH ANACHUNA
Title or Position: CEO
Credential:
Phone: 919-872-1441