MEDICARE: BEAUTIFULLY HUMAN UNDERNEATH LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1790511384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFULLY HUMAN UNDERNEATH LLC

Provider Business Mailing Address
First Line	:	2033 WESTON GREEN LOOP
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-2268
Country	:	US
Telephone Number	:	334-552-0427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 WESTON GREEN LOOP
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-2268
Country	:	US
Telephone Number	:	334-552-0427
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DORTHEA WILSON CALDWELL
Credential	:	LMHC
Telephone Number	:	334-552-0427

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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