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General NPI Number Information
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NPI Number | 1871060160
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Entity Type | Organization
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Legal Business Name | DEPTHWORKS, PLLC
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 901 PAVERSTONE DR STE 9
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City | RALEIGH
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State | NC
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Zip | 27615-4708
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Country | US
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Telephone | 919-623-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 901 PAVERSTONE DR STE 9
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City | RALEIGH
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State | NC
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Zip | 27615-4708
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Country | US
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Telephone | 919-623-8118
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | ANTHONY ANDREW DELMEDICO
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Credential | LMFT
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Telephone | 919-623-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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