Provider Demographics
NPI:1629851605
Name:PAINTING MIRACLES INC.
Entity Type:Organization
Organization Name:PAINTING MIRACLES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:TIBURCIO
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-777-4887
Mailing Address - Street 1:3400 WALSH PKWY STE 218
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1642
Mailing Address - Country:US
Mailing Address - Phone:910-339-2121
Mailing Address - Fax:
Practice Address - Street 1:3400 WALSH PKWY STE 218
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1642
Practice Address - Country:US
Practice Address - Phone:910-339-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center