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General NPI Number Information
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NPI Number | 1720515364
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Entity Type | Organization
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Legal Business Name | BE WELLING THERAPY
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Dates
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Enumeration Date | 05/14/2017
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Last Update Date | 05/14/2017
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Provider Practice Location Address
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Address Line | 4070 BARRETT DR
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City | RALEIGH
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State | NC
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Zip | 27609-6604
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Country | US
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Telephone | 919-589-3551
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Fax |
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Provider Business Mailing Address
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Address Line | 323 PEMBROKE CT
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City | WENDELL
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State | NC
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Zip | 27591-7129
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Country | US
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Telephone | 919-589-3551
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | EMILY JUNE HARRISON
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Credential | LCSW, LCAS
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Telephone | 919-589-3551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | LCAS-20128
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | C009589
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License Number State | NC
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