Provider Demographics
NPI:1871973396
Name:DURHAM LIFESTYLE MANAGEMENT LLC
Entity type:Organization
Organization Name:DURHAM LIFESTYLE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-260-8423
Mailing Address - Street 1:5324 MCFARLAND RD
Mailing Address - Street 2:STE 150
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6865
Mailing Address - Country:US
Mailing Address - Phone:919-354-7077
Mailing Address - Fax:919-354-7075
Practice Address - Street 1:5324 MCFARLAND RD
Practice Address - Street 2:STE 150
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6865
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:919-354-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty