Healthcare Provider Details

I. General information

NPI: 1720515364
Provider Name (Legal Business Name): BE WELLING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 05/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 BARRETT DR
RALEIGH NC
27609-6604
US

IV. Provider business mailing address

323 PEMBROKE CT
WENDELL NC
27591-7129
US

V. Phone/Fax

Practice location:
  • Phone: 919-589-3551
  • Fax:
Mailing address:
  • Phone: 919-589-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberC009589
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberLCAS-20128
License Number State

VIII. Authorized Official

Name: EMILY JUNE HARRISON
Title or Position: OUTPATIENT THERAPIST
Credential: LCSW, LCAS
Phone: 919-589-3551