Healthcare Provider Details

I. General information

NPI: 1104376896
Provider Name (Legal Business Name): GLIMMER OF HOPE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 BULLARD CT SUITE 102
RALEIGH NC
27615-6801
US

IV. Provider business mailing address

1013 BULLARD CT SUITE 102
RALEIGH NC
27615-6801
US

V. Phone/Fax

Practice location:
  • Phone: 919-798-7347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number11045A
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number11045A
License Number StateNC

VIII. Authorized Official

Name: MRS. VICTORIA HOPE ARENDT
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFTA
Phone: 919-798-7347