Healthcare Provider Details

I. General information

NPI: 1568495554
Provider Name (Legal Business Name): INNOVATIVE INTERPRETATIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MINE LAKE CT STE 200
RALEIGH NC
27615-6417
US

IV. Provider business mailing address

154 MINE LAKE CT STE 200
RALEIGH NC
27615-6417
US

V. Phone/Fax

Practice location:
  • Phone: 919-389-9952
  • Fax:
Mailing address:
  • Phone: 919-389-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC005097
License Number StateNC

VIII. Authorized Official

Name: DEBRA K LEEDS
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 919-389-9952