| Modern Change Pllc | |
|
5720 Fayetteville Rd Ste 202 Durham NC 27713-5333 | |
| (919) 576-0084 | |
| (919) 797-9922 |
| Full Name | Modern Change Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5720 Fayetteville Rd Ste 202, Durham, North Carolina |
| Authorized Official Name and Position | Monique Porter (OWNER) |
| Authorized Official Contact | 9195760084 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Change Pllc 5720 Fayetteville Rd Ste 202 Durham NC 27713-5333 Ph: (919) 576-0084 | Modern Change Pllc 5720 Fayetteville Rd Ste 202 Durham NC 27713-5333 Ph: (919) 576-0084 |
| NPI Number | 1790311207 |
|---|---|
| Provider Enumeration Date | 03/16/2020 |
| Last Update Date | 04/18/2024 |
| Certification Date | 04/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790311207 | NPI | - | NPPES |
| 1295187763 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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