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General NPI Number Information
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NPI Number | 1215589817
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Entity Type | Organization
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Legal Business Name | ENRICHMENT SERVICES GROUP LLC
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 140 N STEELE ST STE 17
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City | SANFORD
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State | NC
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Zip | 27330-3967
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Country | US
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Telephone | 919-342-8767
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Fax | 919-869-2558
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Provider Business Mailing Address
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Address Line | 3308 HUNTING BAY DR
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City | SPRING LAKE
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State | NC
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Zip | 28390-1543
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Country | US
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Telephone | 336-212-9236
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LAQUANA RICHMOND
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Credential | LPC LCAS CCS CSOTP
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Telephone | 919-342-8767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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