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General NPI Number Information
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NPI Number | 1922315258
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Entity Type | Organization
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Legal Business Name | A MOMENT'S REFLECTION
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 8510 SIX FORKS RD STE 101
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City | RALEIGH
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State | NC
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Zip | 27615-3258
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Country | US
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Telephone | 919-602-8572
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Fax | 919-747-4172
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Provider Business Mailing Address
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Address Line | 3520 PRITCHARD CT
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City | RALEIGH
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State | NC
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Zip | 27616-8973
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Country | US
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Telephone | 919-602-8572
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Fax | 919-747-4172
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. ELIZABETH MARIE POLOMIK
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Credential | LPC
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Telephone | 919-602-8572
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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 | 5135
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License Number State | NC
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