Organization
GROUPSERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRICE RICHARDSON (MANAGING PARTNER)
(919) 697-6957
Entity
Organization
Contact information
Practice address
1426 E NC HIGHWAY 54, DURHAM, NC 27713-2469
(919) 697-6957
Mailing address
PO BOX 12821, DURHAM, NC 27709-2821
(919) 697-6957
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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