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General NPI Number Information
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NPI Number | 1407156185
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS UNITED, PA
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 183 WIND CHIME CT
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City | RALEIGH
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State | NC
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Zip | 27615-6461
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Country | US
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Telephone | 919-900-7140
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Fax | 919-848-3140
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Provider Business Mailing Address
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Address Line | 183 WIND CHIME CT
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City | RALEIGH
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State | NC
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Zip | 27615-6461
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Country | US
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Telephone | 919-900-7140
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Fax | 919-848-3140
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Authorized Official
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Title or Position | CEO
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Name | MRS. LA VERA C POTTS
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Credential | LPC
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Telephone | 919-900-7140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5073
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License Number State | NC
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