Provider Demographics
NPI:1356711170
Name:THE FREEDOM TO SHINE
Entity type:Organization
Organization Name:THE FREEDOM TO SHINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:954-560-5238
Mailing Address - Street 1:2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-1357
Mailing Address - Country:US
Mailing Address - Phone:954-560-5238
Mailing Address - Fax:888-510-9071
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525-1357
Practice Address - Country:US
Practice Address - Phone:954-560-5238
Practice Address - Fax:888-510-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006302101YM0800X
NC1912101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCSTATE LICENSEOtherP006302
NCSTATE LICENSEOther1912