Organization
A SPACE FOR NICHOLAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAKENA STEWART MSW (OWNER)
(919) 228-8026
Entity
Organization
Contact information
Practice address
2310 S MIAMI BLVD STE 141, DURHAM, NC 27703-4900
(919) 228-8026
Mailing address
6409 FAYETTEVILLE RD STE 120 #185, DURHAM, NC 27713
(919) 228-8026
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
208000000X
Pediatrics Physician
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
11/21/2024
Last updated
01/26/2025
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