MEDICARE: WELLNESS WITHIN PROFESSIONAL COUNSELING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427529155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS WITHIN PROFESSIONAL COUNSELING

Provider Business Mailing Address
First Line	:	111 SHORE DR
Second Line	:
City	:	SHILOH
State	:	NC
Zip	:	27974-6241
Country	:	US
Telephone Number	:	252-339-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N CROATAN HWY STE F
Second Line	:
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-9356
Country	:	US
Telephone Number	:	252-339-4915
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	KATHERINE LYNN DUNAVANT
Credential	:	LPC, NCC
Telephone Number	:	252-339-4915

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/17/2018

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