MEDICARE: S.E.L.F STRENGTHENING AND EMPOWERING THE LIVES OF OUR FUTURE,INC.

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1346360880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.E.L.F STRENGTHENING AND EMPOWERING THE LIVES OF OUR FUTURE,INC.

Provider Business Mailing Address
First Line	:	5401 EVERGREEN FOREST WAY
Second Line	:	102
City	:	RALEIGH
State	:	NC
Zip	:	27616-7920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 EVERGREEN FOREST WAY
Second Line	:	102
City	:	RALEIGH
State	:	NC
Zip	:	27616-7920
Country	:	US
Telephone Number	:	919-325-3700
Fax Number	:

Authorized Official
Title or Position	:	CEO-EXECUTIVE DIRECTOR
Name	:	MS. KATHERINE N HODGE
Credential	:	B.A.
Telephone Number	:	619-507-3977

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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