MEDICARE: FLOYD PSYCHOTHERAPY & CLINICAL CONSULTING 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467921684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOYD PSYCHOTHERAPY & CLINICAL CONSULTING PLLC

Provider Business Mailing Address
First Line	:	107 KNIGHTWOOD DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-6339
Country	:	US
Telephone Number	:	910-264-9779
Fax Number	:	919-746-7449

Provider Business Practice Location Address
First Line	:	2530 MERIDIAN PKWY STE 3104
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	919-251-6973
Fax Number	:	919-746-7449

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RENAE LANETTE EADES
Credential	:	LCSW, SAP
Telephone Number	:	910-264-9779

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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