# DIGITAL HEALTH INNOVATION LEARNING LAB

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

## Provider details

- **NPI number:** 1548064819
- **Authorized official:** JEANETTE ALLEN MBA (GENERAL MANAGER)
- **Authorized official phone:** (989) 708-0349

## Contact information

- **Practice address:** 1519 MECKLENBURG HWY UNIT 362, MOORESVILLE, NC 28123-2016
- **Practice address phone:** (989) 708-0349
- **Mailing address:** 1519 MECKLENBURG HWY UNIT 362, MOORESVILLE, NC 28123-2016
- **Mailing address phone:** (989) 708-0349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YS0200X | School Counselor | — | NULL | — |
| 101YS0200X | School Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 1041S0200X | School Social Worker | — | NULL | — |
| 1041S0200X | School Social Worker | — | — | — |
| 1223D0001X | Public Health Dentistry | — | NULL | — |
| 1223D0001X | Public Health Dentistry | — | — | — |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |
| 163WC1500X | Community Health Registered Nurse | — | NULL | — |
| 163WC1500X | Community Health Registered Nurse | — | — | — |
| 163WG0000X | General Practice Registered Nurse | — | NULL | — |
| 163WG0000X | General Practice Registered Nurse | — | — | — |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | — | NULL | — |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | — | — | — |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | — | — |
| 207QA0505X | Adult Medicine Physician | — | NULL | — |
| 207QA0505X | Adult Medicine Physician | — | — | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | Yes |
| 363LC1500X | Community Health Nurse Practitioner | — | NULL | — |
| 363LC1500X | Community Health Nurse Practitioner | — | — | — |
| 364SC1501X | Community Health/Public Health Clinical Nurse Specialist | — | NULL | — |
| 364SC1501X | Community Health/Public Health Clinical Nurse Specialist | — | — | — |

## Other

- **Enumeration date:** 04/03/2025
- **Last updated:** 04/04/2025