# GO HARD FOR LIFE INTERNATIONAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508253923
- **Authorized official:** DR. JERRY WILLIAM WILEY M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (919) 850-9960

## Contact information

- **Practice address:** 3211 BRAMER DRIVE, RALEIGH, NC 27604-1804
- **Practice address phone:** (919) 850-9960
- **Practice address fax:** (919) 850-9961
- **Mailing address:** 3211 BRAMER DR, RALEIGH, NC 27604-1603
- **Mailing address phone:** (919) 850-9960
- **Mailing address fax:** (919) 268-9660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 21616 | NC | — |
| 101YM0800X | Mental Health Counselor | 21616 | NC | Yes |
| 103TE1100X | Exercise & Sports Psychologist | 21616 | NC | — |
| 104100000X | Social Worker | 21616 | NC | — |
| 106H00000X | Marriage & Family Therapist | 21616 | NC | — |

## Other

- **Enumeration date:** 04/23/2015
- **Last updated:** 05/10/2016