| Primary Source Group, Pllc | |
|
4905 Green Rd Suite 105 Raleigh NC 27616-2805 | |
| (919) 981-7373 | |
| (919) 981-7373 |
| Full Name | Primary Source Group, Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4905 Green Rd, Raleigh, North Carolina |
| Authorized Official Name and Position | Leslie M Hardy (PRESIDENT/OWNER) |
| Authorized Official Contact | 9194343555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Source Group, Pllc Po Box 58098 Raleigh NC 27658-8098 Ph: (919) 434-3555 | Primary Source Group, Pllc 4905 Green Rd Suite 105 Raleigh NC 27616-2805 Ph: (919) 981-7373 |
| NPI Number | 1104052901 |
|---|---|
| Provider Enumeration Date | 06/08/2009 |
| Last Update Date | 07/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104052901 | NPI | - | NPPES |
| 6106329 | Medicaid | NC |
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