Healthcare Provider Details

I. General information

NPI: 1114711819
Provider Name (Legal Business Name): TRUENORTH THERAPY NC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 GUNNISON PL
RALEIGH NC
27609-5104
US

IV. Provider business mailing address

1212 GUNNISON PL
RALEIGH NC
27609-5104
US

V. Phone/Fax

Practice location:
  • Phone: 650-799-7734
  • Fax:
Mailing address:
  • Phone: 650-799-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTHA AGUE
Title or Position: PRESIDENT
Credential:
Phone: 650-799-7734