Provider Demographics
NPI:1790511384
Name:BEAUTIFULLY HUMAN UNDERNEATH LLC
Entity type:Organization
Organization Name:BEAUTIFULLY HUMAN UNDERNEATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORTHEA
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:334-552-0427
Mailing Address - Street 1:2033 WESTON GREEN LOOP
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2268
Mailing Address - Country:US
Mailing Address - Phone:334-552-0427
Mailing Address - Fax:
Practice Address - Street 1:2033 WESTON GREEN LOOP
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2268
Practice Address - Country:US
Practice Address - Phone:334-552-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty