Organization
DEVELOPMENTAL THERAPY OUTREACH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAJINA COOPER (BILLING)
(919) 381-1112
Entity
Organization
Contact information
Practice address
4506 TYNE DR, DURHAM, NC 27703-2891
(919) 596-5047
Mailing address
PO BOX 11928, DURHAM, NC 27703-1928
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302047
—
NC
05
—
8302047K
—
NC
Enumeration date
08/28/2007
Last updated
08/28/2007
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