Provider Demographics
NPI:1396067369
Name:DENOME-MADRAS ALLIANCE
Entity type:Organization
Organization Name:DENOME-MADRAS ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENOME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-384-5904
Mailing Address - Street 1:208 STONE BARN CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7471
Mailing Address - Country:US
Mailing Address - Phone:919-384-5904
Mailing Address - Fax:800-798-2171
Practice Address - Street 1:382 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9047
Practice Address - Country:US
Practice Address - Phone:919-384-9504
Practice Address - Fax:800-798-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005921251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health