Provider Demographics
NPI:1144770876
Name:LOSS INTO TOPAZ: COUNSELING SPECIALIZING IN GRIEF AND PET LOSS, PLLC
Entity Type:Organization
Organization Name:LOSS INTO TOPAZ: COUNSELING SPECIALIZING IN GRIEF AND PET LOSS, PLLC
Other - Org Name:JEHANNE GHEITH, MSW, PHD, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PHD LCSW
Authorized Official - Phone:919-452-9286
Mailing Address - Street 1:400 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1414
Mailing Address - Country:US
Mailing Address - Phone:919-452-9286
Mailing Address - Fax:
Practice Address - Street 1:112 SWIFT AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4883
Practice Address - Country:US
Practice Address - Phone:919-452-9286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0093601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty