Provider Demographics
NPI:1831649995
Name:RESOURCES FOR HUMAN DEVELOPMENT
Entity Type:Organization
Organization Name:RESOURCES FOR HUMAN DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NC UNIT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLISS
Authorized Official - Middle Name:MANAY
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-755-1335
Mailing Address - Street 1:10224 DURANT RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6468
Mailing Address - Country:US
Mailing Address - Phone:919-755-1335
Mailing Address - Fax:
Practice Address - Street 1:2412 FITZGERALD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4738
Practice Address - Country:US
Practice Address - Phone:919-977-1384
Practice Address - Fax:919-875-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 092 940251B00000X
NCMHL-092-940251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418237Medicaid