Healthcare Provider Details

I. General information

NPI: 1326122276
Provider Name (Legal Business Name): OXBRIDGE EDUCATORS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 MUNFORD RD
RALEIGH NC
27612-2621
US

IV. Provider business mailing address

5510 MUNFORD RD
RALEIGH NC
27612-2621
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-7780
  • Fax: 919-882-9933
Mailing address:
  • Phone: 919-870-7780
  • Fax: 919-600-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMHL092625
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. HEATHER C. LORD
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 919-870-7780