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General NPI Number Information
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NPI Number | 1861522138
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Entity Type | Organization
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Legal Business Name | SYSTEMIC HEALTH RESOURCES, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 1100 LOGGER CT G-103
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City | RALEIGH
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State | NC
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Zip | 27609-8525
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Country | US
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Telephone | 800-755-6309
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Fax | 800-755-6309
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Provider Business Mailing Address
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Address Line | PO BOX 99281
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City | RALEIGH
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State | NC
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Zip | 27624-9281
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Country | US
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Telephone | 800-755-6309
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Fax | 800-755-6309
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHAD JORDAN
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Credential |
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Telephone | 800-755-6309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1092
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License Number State | NC
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