MEDICARE: WOMEN, CHILDREN & FAMILY COUNSELING SERVICES 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	101YP2500X	Professional Counselor	4929	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821460437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN, CHILDREN & FAMILY COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	3 TRIPLE CROWN PL
Second Line	:
City	:	BAHAMA
State	:	NC
Zip	:	27503-9616
Country	:	US
Telephone Number	:	252-395-5158
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 S GARNETT ST
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-4571
Country	:	US
Telephone Number	:	252-395-5158
Fax Number	:

Authorized Official
Title or Position	:	CEO/CLINICIAN
Name	:	MRS. SHANDER MEADOWS
Credential	:	MA,LPCS
Telephone Number	:	252-395-5158

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	10/22/2015

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