Provider Demographics
NPI:1861069080
Name:MORSE CLINIC OF DURHAM, PC
Entity type:Organization
Organization Name:MORSE CLINIC OF DURHAM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KORNEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:919-294-9621
Mailing Address - Street 1:4119 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2153
Mailing Address - Country:US
Mailing Address - Phone:919-294-9621
Mailing Address - Fax:919-294-9794
Practice Address - Street 1:4119 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2153
Practice Address - Country:US
Practice Address - Phone:919-294-9621
Practice Address - Fax:919-294-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC251S00000XMedicaid