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General NPI Number Information
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NPI Number | 1396067369
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Entity Type | Organization
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Legal Business Name | DENOME-MADRAS ALLIANCE
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 382 RALEIGH ST
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-9047
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Country | US
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Telephone | 919-384-9504
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Fax | 800-798-2171
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Provider Business Mailing Address
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Address Line | 208 STONE BARN CIR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7471
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Country | US
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Telephone | 919-384-5904
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Fax | 800-798-2171
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SARAH J DENOME
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Credential | LCSW
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Telephone | 919-384-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C005921
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License Number State | NC
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