Organization
GO HARD FOR LIFE INTERNATIONAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY WILLIAM WILEY M.D. (MEDICAL DIRECTOR)
(919) 850-9960
Entity
Organization
Contact information
Practice address
3211 BRAMER DRIVE, RALEIGH, NC 27604-1804
(919) 850-9960
(919) 850-9961
Mailing address
3211 BRAMER DR, RALEIGH, NC 27604-1603
(919) 850-9960
(919) 268-9660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
21616
NC
101YM0800X
Mental Health Counselor
Primary
21616
NC
103TE1100X
Exercise & Sports Psychologist
21616
NC
104100000X
Social Worker
21616
NC
106H00000X
Marriage & Family Therapist
21616
NC
Other
Enumeration date
04/23/2015
Last updated
05/10/2016
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