NPIMap

Organization Active NPI

Melanated Space

  • Counselor
  • Durham, NC
National Provider Identifier
1659119634
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
MELANATED SPACE
Practice address
65 TW Alexander Dr Unit 110122
Durham, NC 27709-0933
Phone
(919) 780-4197
NPI assigned
Jul 16, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Authorized official

Name
Whitley Grant-Goodman, LCMHCS
Title
Owner
Phone
(919) 780-4197

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

65 TW Alexander Dr Unit 110122
Durham, NC 27709-0933

Mailing address

PO Box 110122
Durham, NC 27709-5122
Phone (919) 780-4197

National Provider Directory

National Provider Directory
Tax ID family
Melanated Space2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1659119634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110122",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277095122",
            "telephone_number": "919-780-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 TW ALEXANDER DR UNIT 110122",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277090933",
            "telephone_number": "919-780-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELANATED SPACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "GRANT-GOODMAN",
        "authorized_official_first_name": "WHITLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-780-4197",
        "authorized_official_credential": "LCMHCS"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.