Provider Demographics
NPI:1598237687
Name:PROVEN PROGRESS COUNSELING AND TRAUMA TREATMENT PLLC
Entity Type:Organization
Organization Name:PROVEN PROGRESS COUNSELING AND TRAUMA TREATMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY-GILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-276-0626
Mailing Address - Street 1:9650 STRICKLAND RD STE 103-416
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1902
Mailing Address - Country:US
Mailing Address - Phone:919-276-0626
Mailing Address - Fax:
Practice Address - Street 1:4601 LAKE BOONE TRL STE 2D
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-276-0626
Practice Address - Fax:844-355-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1356664304Medicaid