Healthcare Provider Details

I. General information

NPI: 1174409841
Provider Name (Legal Business Name): TRANSFORMATIVE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 SIX FORKS RD STE 1000
RALEIGH NC
27609-5738
US

IV. Provider business mailing address

4208 SIX FORKS RD STE 1000
RALEIGH NC
27609-5738
US

V. Phone/Fax

Practice location:
  • Phone: 919-341-7182
  • Fax: 919-341-7129
Mailing address:
  • Phone: 919-341-7182
  • Fax: 919-341-7129

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: MARK CHELTENHAM
Title or Position: OWNER
Credential: MD
Phone: 919-855-1152