MEDICARE: CONNECT CENTER FOR WELLNESS

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	103TC0700X	Clinical Psychologist	3936	NC

General Provider Information

NPI Number	:	1801169180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECT CENTER FOR WELLNESS

Provider Business Mailing Address
First Line	:	1802 MLK PKWY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-908-9308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 MARTIN LUTHER KING PKWY STE 107
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3586
Country	:	US
Telephone Number	:	919-908-9308
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANICE L MCGILBERRY
Credential	:	LPA, LCMHCS
Telephone Number	:	919-908-9308

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	07/16/2020

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Directions to “CONNECT CENTER FOR WELLNESS ” Practice Location

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