Healthcare Provider Details

I. General information

NPI: 1750156691
Provider Name (Legal Business Name): RECLAIMED I.D. COUNSELING AND CONSULTATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2938 EBB SHORE DR
ARCHDALE NC
27263-8910
US

IV. Provider business mailing address

2938 EBB SHORE DR
ARCHDALE NC
27263-8910
US

V. Phone/Fax

Practice location:
  • Phone: 336-804-2243
  • Fax:
Mailing address:
  • Phone: 336-804-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASEY WEST
Title or Position: OWNER
Credential: LCMHC
Phone: 336-804-2243