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General NPI Number Information
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NPI Number | 1366729048
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Entity Type | Organization
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Legal Business Name | REDESIGNING LIFE OF N.C.,LL
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 806 TARBORO ST W SUITE A
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City | WILSON
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State | NC
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Zip | 27893-4771
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Country | US
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Telephone | 252-363-4122
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Fax | 252-296-0033
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Provider Business Mailing Address
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Address Line | PO BOX 683
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City | WILSON
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State | NC
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Zip | 27894-0683
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Country | US
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Telephone | 252-363-4122
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Fax | 252-296-0033
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | CHANDRA REVIS PEGUES
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Credential |
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Telephone | 252-363-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MHL-098-173
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License Number State | NC
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