Healthcare Provider Details

I. General information

NPI: 1053154195
Provider Name (Legal Business Name): INTENTIONAL PRACTICE COUNSELING & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PROVIDENCE RD STE 100
CHAPEL HILL NC
27514-2208
US

IV. Provider business mailing address

2813 NEVILLE RD
CHAPEL HILL NC
27516-5485
US

V. Phone/Fax

Practice location:
  • Phone: 919-823-3519
  • Fax:
Mailing address:
  • Phone: 252-944-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE MOBLEY
Title or Position: OWNER/THERAPIST
Credential: MSW, LCSW, LICSW
Phone: 919-823-3519