MEDICARE: ENVISION IT COUNSELING AND COACHING SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205138187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION IT COUNSELING AND COACHING SERVICES

Provider Business Mailing Address
First Line	:	329 FRANK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 FRANK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2111
Country	:	US
Telephone Number	:	704-631-6818
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. BATONYA RANEL MCCULLOUGH
Credential	:
Telephone Number	:	704-631-6818

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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