=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902646862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMNIA PARATUS MENTAL STRENGTH AND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2024
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 E WILLIAMS ST
-----------------------------------------------------
City | APEX
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27502-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-355-8075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2054 ACKERMAN HILL DR
-----------------------------------------------------
City | APEX
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27502-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-924-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SOCIAL WORKER
-----------------------------------------------------
Name | ERIKA HOECKBERG
-----------------------------------------------------
Credential | LCSWA
-----------------------------------------------------
Telephone | 516-924-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------