Provider Demographics
NPI:1659160570
Name:SELF CENTERED LLC
Entity type:Organization
Organization Name:SELF CENTERED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DASHAVONE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT
Authorized Official - Phone:910-835-6275
Mailing Address - Street 1:632 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2512
Mailing Address - Country:US
Mailing Address - Phone:910-390-0107
Mailing Address - Fax:
Practice Address - Street 1:632 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2512
Practice Address - Country:US
Practice Address - Phone:910-390-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty