Provider Demographics
NPI:1467141200
Name:FOUR CORNERS HEALING, LLC
Entity Type:Organization
Organization Name:FOUR CORNERS HEALING, LLC
Other - Org Name:FOUR CORNERS HEALING AND TRAUMA COUNSELING, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER / SUPERVISING THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LCP
Authorized Official - Phone:919-866-2181
Mailing Address - Street 1:411 EMISSARY DR # 109
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-2608
Mailing Address - Country:US
Mailing Address - Phone:919-866-2181
Mailing Address - Fax:
Practice Address - Street 1:225 TALS ROCK WAY STE 6
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1925
Practice Address - Country:US
Practice Address - Phone:970-729-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty