Provider Demographics
NPI:1194344424
Name:NOURISH- A HEALING SPACE, PLLC
Entity type:Organization
Organization Name:NOURISH- A HEALING SPACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ADIA
Authorized Official - Last Name:KUHNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-241-1032
Mailing Address - Street 1:612 WELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7502
Mailing Address - Country:US
Mailing Address - Phone:919-636-0018
Mailing Address - Fax:919-237-9256
Practice Address - Street 1:3001 ACADEMY RD STE 130
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2653
Practice Address - Country:US
Practice Address - Phone:919-241-1032
Practice Address - Fax:919-443-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty