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General NPI Number Information
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NPI Number | 1104517630
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Entity Type | Organization
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Legal Business Name | DAFFODIL WELLNESS CENTER
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 211 E SIX FORKS RD STE 203C
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City | RALEIGH
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State | NC
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Zip | 27609-7753
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Country | US
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Telephone | 919-634-8217
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Fax |
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Provider Business Mailing Address
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Address Line | 211 E SIX FORKS RD STE 203C
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City | RALEIGH
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State | NC
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Zip | 27609-7753
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Country | US
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Telephone | 919-634-8217
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEMETRIA DEMETRIAHAYES
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Credential |
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Telephone | 310-270-1675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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