Organization
VIDEO THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SABRIYA LAILA SHARIF-HANIFA MS, LCASA (CEO)
(919) 758-4559
Entity
Organization
Contact information
Practice address
4208 SIX FORKS RD STE 1000, RALEIGH, NC 27609-5738
(919) 758-4559
(919) 573-0442
Mailing address
4749 COURTNEY LN APT F, RALEIGH, NC 27616-5250
(919) 758-4559
(919) 573-0442
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
3175-A
NC
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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