Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Primary Source Group, PLLC

Organization Addiction (Substance Use Disorder) Counselor · NPI 1104052901

Primary Source Group, PLLC is an Addiction (Substance Use Disorder) Counselor in Raleigh, North Carolina. Licensed in North Carolina. Registered with an NPI since 2009.

Licensed in
NC
In the registry since
2009
Specialties on file
4
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4905 Green Rd Ste 105
Raleigh, NC 27616-2805
Phone: (919) 981-7373
Fax: (919) 981-7373
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence C003663 (NC)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 1222 (NC)
Psychologist Taxonomy 103T00000X · Licence 1572 (NC)
Counseling Psychologist Taxonomy 103TC1900X · Licence 865 (NC)

Record details

NPI number1104052901
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Leslie Hardy — President/Owner · (919) 434-3555
NPI enumeratedJune 8, 2009
Last updated in NPPESJuly 25, 2011
Mailing addressPo Box 58098, Raleigh, NC 27658-8098

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