NPIMap

Organization Active NPI

Devang Family Services

Doing business as Ellie Mental Health-Raleigh

  • Mental Health Counselor
  • Raleigh, NC
National Provider Identifier
1992410716
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
DEVANG FAMILY SERVICES
Doing business as
Ellie Mental Health-Raleigh
Practice address
2709 Blue Ridge Rd Ste 190
Raleigh, NC 27607-0113
Phone
(571) 274-8132
NPI assigned
Jan 16, 2023
Last updated
Mar 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Dr. Samantha Simon, PHD, LCMHC, NCCNPI 1588285167
Title
Clinic Director
Phone
(704) 991-5159

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

2709 Blue Ridge Rd Ste 190
Raleigh, NC 27607-0113

Mailing address

2709 Blue Ridge Rd
Ste 190
Raleigh, NC 27607
Phone (919) 322-0140

Other names 1

  • Ellie Mental Health-Raleigh Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250806002504 NC Part B Supplier - Clinic/Group Practice 7517475866 Receives reassigned benefits from 5 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

2709 Blue Ridge Rd
Ste 190
Raleigh, NC 27607
Phone (571) 274-8132

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1992410716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2709 BLUE RIDGE RD",
            "address_2": "STE 190",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27607",
            "telephone_number": "919-322-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2709 BLUE RIDGE RD STE 190",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276070113",
            "telephone_number": "571-274-8132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVANG FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-16",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "704-991-5159",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LCMHC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health-Raleigh",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.