Organization
MELANATED SPACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WHITLEY GRANT-GOODMAN LCMHCS (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
(919) 780-4197
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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