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General NPI Number Information
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NPI Number | 1518190560
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Entity Type | Organization
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Legal Business Name | REALITY THERAPY
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 930 CAMBRIDGE ST SUITE 108
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-9625
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Country | US
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Telephone | 910-483-1075
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Fax | 910-483-1075
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Provider Business Mailing Address
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Address Line | 930 CAMBRIDGE ST SUITE 108
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-9625
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Country | US
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Telephone | 910-483-1075
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Fax | 910-483-1075
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Authorized Official
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Title or Position | OWNER
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Name | DR. WASHINGTON DENNIS WHITE
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Credential | LPC, LCAS
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Telephone | 910-483-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 98
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3809
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License Number State | NC
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