Healthcare Provider Details

I. General information

NPI: 1104517630
Provider Name (Legal Business Name): DAFFODIL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E SIX FORKS RD STE 203C
RALEIGH NC
27609-7753
US

IV. Provider business mailing address

211 E SIX FORKS RD STE 203C
RALEIGH NC
27609-7753
US

V. Phone/Fax

Practice location:
  • Phone: 919-634-8217
  • Fax:
Mailing address:
  • Phone: 919-634-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEMETRIA DEMETRIAHAYES
Title or Position: OWNER
Credential:
Phone: 310-270-1675