Healthcare Provider Details

I. General information

NPI: 1114723228
Provider Name (Legal Business Name): UNFILTERED DREAMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W WADDELL ST
SELMA NC
27576-2025
US

IV. Provider business mailing address

PO BOX 15
CLAYTON NC
27528-0015
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-5786
  • Fax:
Mailing address:
  • Phone: 919-622-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: TYESHA SANDERS
Title or Position: MANAGER
Credential: CPSS
Phone: 919-622-5786