Provider Demographics
NPI:1053622266
Name:U.P.L.I.F.T. ENRICHMENT CENTER, INC.
Entity type:Organization
Organization Name:U.P.L.I.F.T. ENRICHMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AYANAH
Authorized Official - Middle Name:DAA'IYAH
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QMHP
Authorized Official - Phone:919-672-3405
Mailing Address - Street 1:5108 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2421
Mailing Address - Country:US
Mailing Address - Phone:919-451-8530
Mailing Address - Fax:877-487-3012
Practice Address - Street 1:5108 REVERE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2421
Practice Address - Country:US
Practice Address - Phone:919-451-8530
Practice Address - Fax:877-487-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24882251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health