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General NPI Number Information
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NPI Number | 1205226909
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Entity Type | Organization
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Legal Business Name | RALEIGH PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 4016 BARRETT DRIVE SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-824-9102
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Fax | 919-824-9102
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Provider Business Mailing Address
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Address Line | 4016 BARRETT DRIVE SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-824-9102
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Fax | 919-883-4515
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/OWNER
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Name | DR. BEVERLY M SIMMONS
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Credential | PHD, LCSW
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Telephone | 919-824-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005387
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License Number State | NC
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