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Organization

DIVERSE WELLNESS SOLUTIONS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KIMBALL JANE-MARIE SARGENT MSN, PMHCNS-BC (OWNER/PRESIDENT)
(919) 838-0804
Entity
Organization

Contact information

Practice address
7155 SUNSET LAKE RD, FUQUAY VARINA, NC 27526-8638
(919) 838-0804
(919) 838-1219
Mailing address
7155 SUNSET LAKE RD, FUQUAY VARINA, NC 27526-8638
(919) 838-0804
(919) 838-1219

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
0261495-01
NC
261QM0855X
Adolescent and Children Mental Health Clinic/Center
0261495-01
NC
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
0261495-01
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10079
BCBS
NC
01
527619
VALUE OPTIONS
NC
05
6004025
NC
01
NC1277A203
MEDICARE PTAN
NC
05
NCMC030788
NC
Enumeration date
05/06/2011
Last updated
01/06/2016
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