Organization
ENRICHMENT SERVICES GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAQUANA RICHMOND LPC LCAS CCS CSOTP (CLINICAL DIRECTOR)
(919) 342-8767
Entity
Organization
Contact information
Practice address
140 N STEELE ST STE 17, SANFORD, NC 27330-3967
(919) 342-8767
(919) 869-2558
Mailing address
3308 HUNTING BAY DR, SPRING LAKE, NC 28390-1543
(336) 212-9236
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
175T00000X
Peer Specialist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801183850
—
NC
Enumeration date
07/12/2019
Last updated
07/12/2019
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