Provider Demographics
NPI:1730581901
Name:IMAGES , 'OF ME TO YOU'
Entity type:Organization
Organization Name:IMAGES , 'OF ME TO YOU'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D H
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:(LCAS-A) LIC#3306
Authorized Official - Phone:828-238-3354
Mailing Address - Street 1:2823 CASCADILLA ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4411
Mailing Address - Country:US
Mailing Address - Phone:828-238-3354
Mailing Address - Fax:
Practice Address - Street 1:2823 CASCADILLA STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:828-238-3354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMAGES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3306-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicaid