Provider Demographics
NPI:1316792146
Name:EMBODIED HEALING PLLC
Entity type:Organization
Organization Name:EMBODIED HEALING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-318-3203
Mailing Address - Street 1:2423 BELLWYND DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-3011
Mailing Address - Country:US
Mailing Address - Phone:984-318-3635
Mailing Address - Fax:
Practice Address - Street 1:5015 SOUTHPARK DR STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7736
Practice Address - Country:US
Practice Address - Phone:984-318-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty