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PRIMARY SOURCE GROUP PLLC NPI 1104052901


NPI Information

NPI: 1104052901
Provider Name: PRIMARY SOURCE GROUP, PLLC
Classification: Social Worker - 1041C0700X
Entity Type: Organization

Specialization: Clinical

Address:
4905 GREEN RD
SUITE 105
RALEIGH, NC
ZIP 27616
Phone: (919) 981-7373
Get Directions

PRIMARY SOURCE GROUP, PLLC is a clinical social worker in Raleigh, NC. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. PRIMARY SOURCE GROUP, PLLC NPI is 1104052901. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4905 GREEN RD
SUITE 105
RALEIGH, NC
ZIP 27616-805
Phone: (919) 981-7373
Fax: (919) 981-7373

The provider's authorized official is Leslie M Hardy .
The authorized official title is President/owner and has the following contact phone number (919) 434-3555.

The enumeration date for this NPI number is 6/8/2009 and was last updated on 7/25/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YA0400XCounselorAddiction (Substance Use Disorder)1222NORTH CAROLINANo
2103T00000XPsychologist1572NORTH CAROLINANo
3103TC1900XPsychologistCounseling865NORTH CAROLINANo
41041C0700XSocial WorkerClinicalC003663NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16106329MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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