Provider Demographics
NPI:1144827064
Name:HIDDEN WOUNDS FAMILY THERAPY PLLC
Entity type:Organization
Organization Name:HIDDEN WOUNDS FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MARRIAGE AND FAMILY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ELLSWORTH
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:919-762-6558
Mailing Address - Street 1:201 E ACADEMY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2248
Mailing Address - Country:US
Mailing Address - Phone:919-762-6558
Mailing Address - Fax:
Practice Address - Street 1:201 E ACADEMY ST STE 110
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2248
Practice Address - Country:US
Practice Address - Phone:919-762-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty