Basic Information
| Provider Information | |||||||||
| NPI: | 1255572830 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NC TRAINING HELP, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NC FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3509 HAWORTH DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198967536 | ||||||||
| FaxNumber: | 9198967537 | ||||||||
| Practice Location | |||||||||
| Address1: | 3509 HAWORTH DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198967536 | ||||||||
| FaxNumber: | 9198967537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2009 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GRADY | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9198967536 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LPC, NCC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 4766 | NC | N | Agencies | Community/Behavioral Health | 101YP2500X | 4766 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 8302727B | 05 | NC | MEDICAID | 6102727 | 05 | NC | MEDICAID | 6006768 | 05 | NC | MEDICAID | 8302727H | 05 | NC | MEDICAID |