Provider Demographics
NPI:1457932550
Name:NUTRITION & DIABETES COUNSELING CENTER OF NC, LLC
Entity Type:Organization
Organization Name:NUTRITION & DIABETES COUNSELING CENTER OF NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, LDN, CDCES
Authorized Official - Phone:919-524-6551
Mailing Address - Street 1:527 KEISLER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9306
Mailing Address - Country:US
Mailing Address - Phone:919-524-6551
Mailing Address - Fax:844-364-9280
Practice Address - Street 1:527 KEISLER DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9306
Practice Address - Country:US
Practice Address - Phone:919-524-6551
Practice Address - Fax:844-364-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty