Healthcare Provider Details

I. General information

NPI: 1346156940
Provider Name (Legal Business Name): SEAGRASS INTEGRATED MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 WALNUT ST STE 18
WILMINGTON NC
28401-4063
US

IV. Provider business mailing address

313 WALNUT ST STE 18
WILMINGTON NC
28401-4063
US

V. Phone/Fax

Practice location:
  • Phone: 910-668-0268
  • Fax: 910-446-8622
Mailing address:
  • Phone: 910-668-0268
  • Fax: 910-446-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TANYA FOWLER
Title or Position: OWNER
Credential: PMHNP
Phone: 910-668-0268