Healthcare Provider Details

I. General information

NPI: 1255010187
Provider Name (Legal Business Name): HEALED AND EDUCATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N ROGERS LANE STE 121 PMB 2061
RALEIGH NC
27610
US

IV. Provider business mailing address

1030 N ROGERS LANE STE 121 PMB 2061
RALEIGH NC
27610
US

V. Phone/Fax

Practice location:
  • Phone: 910-336-2293
  • Fax:
Mailing address:
  • Phone: 910-336-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMISHA JOHNSON
Title or Position: OWNER
Credential: LCSW-A
Phone: 910-336-2293