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General NPI Number Information
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NPI Number | 1902790546
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Entity Type | Organization
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Legal Business Name | THE CENTRE FOR HEALING AND ENLIGHTENMENT
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 4030 WAKE FOREST RD # 349
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City | RALEIGH
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State | NC
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Zip | 27609-0010
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Country | US
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Telephone | 773-242-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78731-4298
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Country | US
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Telephone | 773-242-9333
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Fax | 773-242-9333
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORK SUPER
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Name | MR. DERECK ALEXANDER
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Credential | LCSW-S
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Telephone | 773-242-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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