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General NPI Number Information
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NPI Number | 1306477005
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Entity Type | Organization
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Legal Business Name | OWN YOUR DREAM
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 06/11/2022
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Provider Practice Location Address
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Address Line | 1631 MIDTOWN PL STE 104
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City | RALEIGH
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State | NC
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Zip | 27609-1300
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Country | US
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Telephone | 919-432-2806
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Fax |
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Provider Business Mailing Address
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Address Line | 1631 MIDTOWN PL STE 104 RM 144
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City | RALEIGH
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State | NC
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Zip | 27609-1300
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Country | US
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Telephone | 919-438-3577
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | LANIESHA MERRITT
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Credential |
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Telephone | 919-432-2806
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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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