Healthcare Provider Details

I. General information

NPI: 1710769047
Provider Name (Legal Business Name): ERICA DRISCOLL PENNY NCLCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 PEMBERTON HILL RD STE 202
APEX NC
27502-4266
US

IV. Provider business mailing address

1011 PEMBERTON HILL RD STE 202
APEX NC
27502-4266
US

V. Phone/Fax

Practice location:
  • Phone: 984-256-8754
  • Fax:
Mailing address:
  • Phone: 984-256-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number704161
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA19271
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: