MEDICARE: KC COUNSELING, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871318733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	3689 SHADOW RIDGE DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8404
Country	:	US
Telephone Number	:	252-375-6612
Fax Number	:

Provider Business Practice Location Address
First Line	:	3689 SHADOW RIDGE DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8404
Country	:	US
Telephone Number	:	336-863-3214
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY CAPEL
Credential	:	LCMHC
Telephone Number	:	252-375-6612

Provider Enumeration Date	:	11/16/2024
Last Update Date	:	11/16/2024

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