Healthcare Provider Details

I. General information

NPI: 1417080607
Provider Name (Legal Business Name): THE ASPEN CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 BLAND ROAD
RALEIGH NC
27609-6125
US

IV. Provider business mailing address

4328 BLAND ROAD
RALEIGH NC
27609-6125
US

V. Phone/Fax

Practice location:
  • Phone: 919-981-6588
  • Fax: 919-981-6255
Mailing address:
  • Phone: 919-981-6588
  • Fax: 919-981-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3874
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA SMITH
Title or Position: PRESIDENT
Credential: MACCCSLP
Phone: 919-981-6588