Organization
MELANATED SPACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WHITLEY GRANT (OWNER)
(919) 780-4197
Entity
Organization
Contact information
Practice address
65 TW ALEXANDER DR UNIT 110122, DURHAM, NC 27709-0933
(919) 780-4197
Mailing address
PO BOX 110122, DURHAM, NC 27709-5122
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/02/2025
Last updated
10/02/2025
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