Sozo Life and Wellness Center, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6760 Issued in NC

Legal business name

SOZO LIFE AND WELLNESS CENTER, PLLC

Practice address

3805 Ramblewood Ave
Durham, NC 27713

Phone

(919) 695-3943

Fax

(919) 767-9652

NPI assigned

Mar 12, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Wanda Kay Ceres, LPC

Title

Owner

Phone

(919) 695-3943

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DivaKay Former legal business name

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1154592657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51014",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277171014",
            "telephone_number": "919-695-3943",
            "fax_number": "919-767-9652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 RAMBLEWOOD AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27713",
            "telephone_number": "919-695-3943",
            "fax_number": "919-767-9652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOZO LIFE AND WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "CERES",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-695-3943",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "6760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103721",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DivaKay",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Benjamin Soydan, P.T.
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• Felicia Spadini, APRN
• Joshua Paul Spaete
• Tede Spahn
• Emily Nicole Spain

• Community/Behavioral Health Agency in Durham, NC
• Providers in Durham, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.