Provider Demographics
NPI:1750648457
Name:INNOVATION THERAPIES, PLLC
Entity type:Organization
Organization Name:INNOVATION THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:SHAVON
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, MSW
Authorized Official - Phone:919-593-3340
Mailing Address - Street 1:756-402 CL TART CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:919-593-3340
Mailing Address - Fax:919-550-2397
Practice Address - Street 1:3201 YORKTOWN AVE STE 117D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1474
Practice Address - Country:US
Practice Address - Phone:919-593-3340
Practice Address - Fax:919-550-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health