Provider Demographics
NPI:1073285326
Name:THERAPEUTIC KONEC, PLLC
Entity Type:Organization
Organization Name:THERAPEUTIC KONEC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OZELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-408-1874
Mailing Address - Street 1:3600 N DUKE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1769
Mailing Address - Country:US
Mailing Address - Phone:919-408-1874
Mailing Address - Fax:
Practice Address - Street 1:3600 N DUKE ST STE 1085
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1709
Practice Address - Country:US
Practice Address - Phone:919-408-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty