Provider Demographics
NPI:1699598862
Name:COURAGEOUS JOURNEYS HEALING CENTER PLLC
Entity type:Organization
Organization Name:COURAGEOUS JOURNEYS HEALING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:DUKES
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:336-740-6167
Mailing Address - Street 1:653 GRASSWREN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9143
Mailing Address - Country:US
Mailing Address - Phone:336-740-6167
Mailing Address - Fax:
Practice Address - Street 1:2 CENTERVIEW DR STE 43
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3708
Practice Address - Country:US
Practice Address - Phone:984-221-9781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063147288Medicaid