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NPI Code Detail

MEDICARE: EMBODIED HEALING PLLC

MEDICARE: EMBODIED HEALING PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1316792146
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMBODIED HEALING PLLC
Provider Business Mailing Address
First Line : 331 S WEST ST
Second Line :
City : CARY
State : NC
Zip : 27511-3237
Country : US
Telephone Number : 984-318-3203
Fax Number : 855-461-3457
Provider Business Practice Location Address
First Line : 5015 SOUTHPARK DR STE 250
Second Line :
City : DURHAM
State : NC
Zip : 27713-7736
Country : US
Telephone Number : 984-318-3203
Fax Number :
Authorized Official
Title or Position : OUTPATIENT PSYCHOTHERAPIST
Name : SANJA BROER
Credential : LCSW
Telephone Number : 984-318-3203
Provider Enumeration Date : 04/23/2024
Last Update Date : 04/23/2026

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Directions to “EMBODIED HEALING PLLC ” Practice Location

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