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General NPI Number Information
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NPI Number | 1841439684
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE HUMAN SERVICES, INC.
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 3722 BENSON DR STE 101
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City | RALEIGH
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State | NC
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Zip | 27609-7321
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Country | US
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Telephone | 919-830-5749
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Fax |
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Provider Business Mailing Address
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Address Line | 3722 BENSON DR STE 101
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City | RALEIGH
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State | NC
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Zip | 27609-7321
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Country | US
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Telephone | 919-830-5749
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CHARLES F. BLACKBURN
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Credential | PH.D.
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Telephone | 919-830-5749
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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 | 3290
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License Number State | NC
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