Healthcare Provider Details

I. General information

NPI: 1629554027
Provider Name (Legal Business Name): WELLNESS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5269 US HIGHWAY 158
ADVANCE NC
27006-6905
US

IV. Provider business mailing address

5269 US HIGHWAY 158
ADVANCE NC
27006-6905
US

V. Phone/Fax

Practice location:
  • Phone: 336-486-7306
  • Fax:
Mailing address:
  • Phone: 703-489-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CELINE BONGAERTS
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 336-486-7306