Rebel Goat Farm,Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

REBEL GOAT FARM,INC

Practice address

250 Millionaire Rd
Saint Pauls, NC 28384-8251

Phone

(910) 241-3273

NPI assigned

Dec 7, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Mary Wahlman

Title

Director and Co-Founder

Phone

(910) 241-3273

Specialties & licenses 6

Addresses

Electronic endpoints 1

Practitioners 1

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

• Dyanna Lynn Russell, B.S, CADC

  • Addiction (Substance Use Disorder) Counselor
  • Saint Pauls, NC
  • NPI 1194312132
  NPD

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1649876566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 MILLIONAIRE RD",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283848251",
            "telephone_number": "910-241-3273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MILLIONAIRE RD",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283848251",
            "telephone_number": "910-241-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBEL GOAT FARM,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "WAHLMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR AND CO-FOUNDER",
        "authorized_official_telephone_number": "910-241-3273",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer.wahlman@rebelgoatfarm.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "250 Millionaire Rd",
            "city": "Saint Pauls",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283848251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Primary Health Choice, Inc
• Primary Health Choice, Inc.
• Primary Health Choice, Inc.
• Keshanda Iesha Purcell
• Amy Danielle Raudenbush
• Jamara Myia Richardson, LSCWA, LCASA
• Righteous Home Care Services, Inc
• Robeson Health Care Corporation (St Pauls Health Center)
• Karis Rozier
• Dyanna Lynn Russell, B.S, CADC

• Clinical Social Worker in Saint Pauls, NC
• Providers in Saint Pauls, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.