Healthcare Provider Details

I. General information

NPI: 1740107127
Provider Name (Legal Business Name): DAISY GOMEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 ARCO CORPORATE DR STE 120
RALEIGH NC
27617-2026
US

IV. Provider business mailing address

257 N HICKORY ST
ANGIER NC
27501-8985
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22895
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: