MEDICARE: STRENGTH HARBOR PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134968621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRENGTH HARBOR PLLC

Provider Business Mailing Address
First Line	:	3403 TIMBER MILL DR
Second Line	:
City	:	STALLINGS
State	:	NC
Zip	:	28104-1156
Country	:	US
Telephone Number	:	803-670-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3403 TIMBER MILL DR
Second Line	:
City	:	STALLINGS
State	:	NC
Zip	:	28104-1156
Country	:	US
Telephone Number	:	803-670-0512
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH COUNSELOR
Name	:	IGNACIO BIDEGAIN
Credential	:	LCMHCA
Telephone Number	:	803-670-0512

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/23/2024

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