Healthcare Provider Details

I. General information

NPI: 1821869439
Provider Name (Legal Business Name): SUNSHINE ADVANTAGE OF NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FAYETTEVILLE ST STE 1100
RALEIGH NC
27601-3000
US

IV. Provider business mailing address

1439 SOUTH ST
LAKEWOOD NJ
08701-5440
US

V. Phone/Fax

Practice location:
  • Phone: 347-971-0039
  • Fax:
Mailing address:
  • Phone: 347-971-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MIRIAM LICHTSCHEIN
Title or Position: MEMBER
Credential:
Phone: 347-971-0039