Healthcare Provider Details

I. General information

NPI: 1174648208
Provider Name (Legal Business Name): MY CAT KARMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11208 IVY CREEK TRL
WAKE FOREST NC
27587-6438
US

IV. Provider business mailing address

11208 IVY CREEK TRAIL
WAKE FOREST NC
27582-6438
US

V. Phone/Fax

Practice location:
  • Phone: 919-523-0910
  • Fax: 919-562-6588
Mailing address:
  • Phone: 919-523-0910
  • Fax: 919-562-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC004514
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC004514
License Number StateNC

VIII. Authorized Official

Name: MS. VICKI DAWN ESLICK
Title or Position: PRESIDENT MY CAT KARMA INC
Credential: LCSW
Phone: 919-523-0910