Healthcare Provider Details

I. General information

NPI: 1376733352
Provider Name (Legal Business Name): JOE HAZEL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274A W DEPOT ST
ANGIER NC
27501-8861
US

IV. Provider business mailing address

274A W DEPOT ST P.O. BOX 1893
ANGIER NC
27501-8861
US

V. Phone/Fax

Practice location:
  • Phone: 919-272-5881
  • Fax: 919-329-9848
Mailing address:
  • Phone: 919-272-5881
  • Fax: 919-329-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number596
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number596
License Number StateNC

VIII. Authorized Official

Name: MR. JOE WAYNE HAZEL
Title or Position: DIRECTOR
Credential: LCAS/CCS
Phone: 919-272-5881