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General NPI Number Information
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NPI Number | 1457126534
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Entity Type | Organization
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Legal Business Name | MIRALIFE TELE-THERAPIST
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 4315 50TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20016-4369
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Country | US
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Telephone | 910-805-2740
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Fax | 910-939-1674
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Provider Business Mailing Address
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Address Line | 3434 KILDAIRE FARM RD
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City | CARY
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State | NC
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Zip | 27518-2277
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Country | US
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Telephone | 910-805-2740
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Fax |
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Authorized Official
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Title or Position | AO
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Name | JANNY N JINOR
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Credential |
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Telephone | 910-805-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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