Provider Demographics
NPI:1962848051
Name:DEVELOPMENTAL DISCOVERIES
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISCOVERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:GOODMAN
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:919-418-7175
Mailing Address - Street 1:307 S SALEM ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1845
Mailing Address - Country:US
Mailing Address - Phone:919-418-7175
Mailing Address - Fax:
Practice Address - Street 1:307 S SALEM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1845
Practice Address - Country:US
Practice Address - Phone:919-418-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303211Medicaid