Organization
THERAPEUTIC VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEYMIAN CRISP (PRACTICE MANAGER)
(336) 510-0653
Entity
Organization
Contact information
Practice address
8386 SIX FORKS RD STE 101, RALEIGH, NC 27615-5088
(336) 933-1204
(336) 510-0926
Mailing address
8386 SIX FORKS RD STE 101, RALEIGH, NC 27615-5088
(336) 933-1204
(336) 510-0926
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/28/2024
Last updated
10/23/2024
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