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General NPI Number Information
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NPI Number | 1124161047
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Entity Type | Organization
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Legal Business Name | LEONE STAR HOME
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8600 NEUSE HUNTER DR
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City | RALEIGH
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State | NC
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Zip | 27616-7735
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Country | US
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Telephone | 919-713-0323
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 NEUSE HUNTER DR
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City | RALEIGH
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State | NC
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Zip | 27616-7735
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Country | US
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Telephone | 919-713-0323
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LAMIN DABOR
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Credential |
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Telephone | 919-713-0323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHL 092 638
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License Number State | NC
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