Go Hard for Life International

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

21616 Issued in NC

Legal business name

GO HARD FOR LIFE INTERNATIONAL

Practice address

3211 Bramer Drive
Raleigh, NC 27604-1804

Phone

(919) 850-9960

Fax

(919) 850-9961

NPI assigned

Apr 23, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jerry William Wiley, M.D.

Title

Medical Director

Phone

(919) 850-9960

Specialties & licenses 5

Addresses

Tax ID family

Go Hard for Life International3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Go Hard for Life International

  • Pediatrics Physician
  • Raleigh, NC
  • NPI 1043689565
  NPD tax ID
• Go Hard Institute and Resorse Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Raleigh, NC
  • NPI 1184088338
  NPD tax ID

Practitioners 1

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

• Donnie McQueen

  • Family Psychologist
  • Raleigh, NC
  • NPI 1477081784
  NPD (past)

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1508253923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 BRAMER DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276041603",
            "telephone_number": "919-850-9960",
            "fax_number": "919-268-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3211 BRAMER DRIVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276041804",
            "telephone_number": "919-850-9960",
            "fax_number": "919-850-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GO HARD FOR LIFE INTERNATIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "919-850-9960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "21616",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "21616",
            "primary": true
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": "NC",
            "license": "21616",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NC",
            "license": "21616",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "21616",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Glynn-Servedio, PHARM.D.
• Martus Zheng Quan GN
• Marlene Gnatek, LCSW
• Tinamarie Gnolfo
• Go Hard for Life International
• Go Hard Institute and Resorse Group
• Betty Sy Go, M.D.
• Brian M Go, M.D.
• Aja Bianca Gobar, DDS
• Julie Marie Gochnour, MD

• 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 May 10, 2016; 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.