Provider Demographics
NPI:1346879103
Name:CULTIVATING WELLNESS THERAPEUTIC & CONSULTING SERVICES, PLLC
Entity Type:Organization
Organization Name:CULTIVATING WELLNESS THERAPEUTIC & CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMONIA
Authorized Official - Middle Name:LAY
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-225-8242
Mailing Address - Street 1:1305 CORWITH DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9545
Mailing Address - Country:US
Mailing Address - Phone:919-408-7686
Mailing Address - Fax:919-646-5011
Practice Address - Street 1:1415 WEST HIGHWAY 54
Practice Address - Street 2:300-214
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-408-7686
Practice Address - Fax:919-646-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487995296Medicaid