Healthcare Provider Details

I. General information

NPI: 1174214191
Provider Name (Legal Business Name): AVANTI COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 WOODLANDS CREEK WAY
APEX NC
27502-5247
US

IV. Provider business mailing address

1126 WOODLANDS CREEK WAY
APEX NC
27502-5247
US

V. Phone/Fax

Practice location:
  • Phone: 919-270-8526
  • Fax:
Mailing address:
  • Phone: 919-270-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: BLANCHE MIKHAIL
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCMHC
Phone: 919-270-8526