Healthcare Provider Details

I. General information

NPI: 1962860155
Provider Name (Legal Business Name): MR. DOUGLAS NGATUNYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 MARATHON LN
RALEIGH NC
27616-0780
US

IV. Provider business mailing address

5105 MARATHON LN
RALEIGH NC
27616-0780
US

V. Phone/Fax

Practice location:
  • Phone: 919-717-7554
  • Fax:
Mailing address:
  • Phone: 919-717-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12253
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-21369
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023656
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: