Provider Demographics
NPI:1124304316
Name:R-M INNOVATED, PLLC
Entity type:Organization
Organization Name:R-M INNOVATED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:910-824-4760
Mailing Address - Street 1:519 N PLATTE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2731
Mailing Address - Country:US
Mailing Address - Phone:910-824-4760
Mailing Address - Fax:
Practice Address - Street 1:523 N PLATTE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2731
Practice Address - Country:US
Practice Address - Phone:910-824-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007879Medicaid