Healthcare Provider Details

I. General information

NPI: 1528727385
Provider Name (Legal Business Name): MARIANNA DURFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GARNER RD STE 113
RALEIGH NC
27610-4687
US

IV. Provider business mailing address

2101 GARNER RD STE 113
RALEIGH NC
27610-4687
US

V. Phone/Fax

Practice location:
  • Phone: 919-832-4453
  • Fax:
Mailing address:
  • Phone: 919-832-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27508
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017111
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: