Our Treatment Center

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7134 Issued in NC

Legal business name

OUR TREATMENT CENTER

Practice address

4909 Waters Edge Dr
104
Raleigh, NC 27606-2462

Phone

(919) 601-1313

NPI assigned

Jan 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tasha Holland-Kornegay, PHD, LPC

Title

Owner

Phone

(919) 601-1313

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tasha L Kornegay, PHD

  • Counselor
  • Raleigh, NC
  • NPI 1295986495

  Mental Health

  NPD
• Ifeoma Tonia Ezugwu

  • Mental Health Counselor
  • Raleigh, NC
  • NPI 1184236077
  NPD (past)
• Maria Isabel Flores- Estrada, MSW, LCSWA

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1215421243
  NPD (past)
• Janise Shanell Kendrick, LCSWA

  • Clinical Social Worker
  • Fayetteville, NC
  • NPI 1962053116
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1134424542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 SHERIFF WATSON RD",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273326720",
            "telephone_number": "919-601-1313",
            "fax_number": "919-267-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 WATERS EDGE DR",
            "address_2": "104",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276062462",
            "telephone_number": "919-601-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-14",
        "last_updated": "2022-07-11",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "HOLLAND-KORNEGAY",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-601-1313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "7134",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6008508",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mustafa Oudeh, PHARMD
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• Christopher Outlaw

• Mental Health Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.