=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023894201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CURATIVE MIND HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2023
-----------------------------------------------------
Last Update Date | 09/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 CHECKMATE CT
-----------------------------------------------------
City | CAMERON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28326-0019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-226-2867
-----------------------------------------------------
Fax | 949-437-8409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 243 CHECKMATE CT
-----------------------------------------------------
City | CAMERON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28326-0019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-226-2867
-----------------------------------------------------
Fax | 949-437-8409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TIMOTHY NEWSOME
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-226-2867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------