Healthcare Provider Details

I. General information

NPI: 1548484546
Provider Name (Legal Business Name): ACHIEVABLE THERAPEUTIC INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 OLD POOLE RD STE 107
RALEIGH NC
27610-3285
US

IV. Provider business mailing address

109 SMART CT
CLAYTON NC
27520-1849
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-2261
  • Fax: 919-231-2219
Mailing address:
  • Phone: 919-412-7502
  • Fax: 919-231-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. DARRYL POWELL PEEBLES JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-412-7502