Healthcare Provider Details

I. General information

NPI: 1215589817
Provider Name (Legal Business Name): ENRICHMENT SERVICES GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N STEELE ST STE 17
SANFORD NC
27330-3967
US

IV. Provider business mailing address

3308 HUNTING BAY DR
SPRING LAKE NC
28390-1543
US

V. Phone/Fax

Practice location:
  • Phone: 919-342-8767
  • Fax: 919-869-2558
Mailing address:
  • Phone: 336-212-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAQUANA RICHMOND
Title or Position: CLINICAL DIRECTOR
Credential: LPC LCAS CCS CSOTP
Phone: 919-342-8767