Provider Demographics
NPI:1619044799
Name:DOMINION MINISTRIES
Entity Type:Organization
Organization Name:DOMINION MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILFORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-416-1830
Mailing Address - Street 1:1530 N GREGSON ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1155
Mailing Address - Country:US
Mailing Address - Phone:919-416-1830
Mailing Address - Fax:919-416-8883
Practice Address - Street 1:1530 N GREGSON ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1155
Practice Address - Country:US
Practice Address - Phone:919-416-1830
Practice Address - Fax:919-416-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032-354251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300909BMedicaid
NC8300909GMedicaid