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General NPI Number Information
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NPI Number | 1205651627
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Entity Type | Organization
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Legal Business Name | HEALING SPACES PLLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 01/26/2025
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Provider Practice Location Address
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Address Line | 2310 S MIAMI BLVD STE 141
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City | DURHAM
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State | NC
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Zip | 27703-4900
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Country | US
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Telephone | 984-313-2526
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Fax |
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Provider Business Mailing Address
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Address Line | 6409 FAYETTEVILLE RD STE 120
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City | DURHAM
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State | NC
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Zip | 27713-6297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAKENA ST
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Credential | MSW
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Telephone | 984-313-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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