Healthcare Provider Details

I. General information

NPI: 1457650681
Provider Name (Legal Business Name): SAFE HARBOR CHRISTIAN COUNSELING OF RALEIGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 BEACHWOOD DR
SANFORD NC
27330-9271
US

IV. Provider business mailing address

2019 BEACHWOOD DR
SANFORD NC
27330-9271
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-7440
  • Fax: 410-569-0094
Mailing address:
  • Phone: 919-774-7440
  • Fax: 410-569-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4891
License Number StateNC

VIII. Authorized Official

Name: CYNTHIA JACOBS
Title or Position: DIRECTOR
Credential: LPC
Phone: 919-774-7440