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General NPI Number Information
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NPI Number | 1316676380
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Entity Type | Organization
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Legal Business Name | HEAL ON WHEELS OF NC, PLLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 76 LOUISE ST
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City | GATES
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State | NC
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Zip | 27937-9834
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Country | US
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Telephone | 252-370-5222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2977
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City | ELIZABETH CITY
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State | NC
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Zip | 27906-2977
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Country | US
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Telephone | 252-370-5222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONDESHYA K COSBY
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Credential | PMHNP-BC
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Telephone | 252-370-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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