Healthcare Provider Details

I. General information

NPI: 1821538877
Provider Name (Legal Business Name): INNERLOGIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NAVAHO DR STE GL150
RALEIGH NC
27609-7318
US

IV. Provider business mailing address

1001 NAVAHO DR STE GL150
RALEIGH NC
27609-7318
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-9246
  • Fax:
Mailing address:
  • Phone: 919-322-9246
  • Fax: 919-882-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA ANDERSON
Title or Position: OWNER
Credential: FNP-C
Phone: 919-322-9246