Provider Demographics
NPI:1104611532
Name:INSPIRED 2 CHANGE LIFE INTEGRATED THERAPY AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:INSPIRED 2 CHANGE LIFE INTEGRATED THERAPY AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HAGANS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MSIHS, LCSWA
Authorized Official - Phone:919-522-3877
Mailing Address - Street 1:400 WOODS OF NORTH BEND DR APT D
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3948
Mailing Address - Country:US
Mailing Address - Phone:919-522-3877
Mailing Address - Fax:
Practice Address - Street 1:3111 LAKE WOODARD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3246
Practice Address - Country:US
Practice Address - Phone:919-522-3877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty