Healthcare Provider Details

I. General information

NPI: 1043826654
Provider Name (Legal Business Name): TRINITY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 E WT HARRIS BLVD STE 120
CHARLOTTE NC
28215-3604
US

IV. Provider business mailing address

PO BOX 44324
CHARLOTTE NC
28215-0047
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-2446
  • Fax: 704-333-2447
Mailing address:
  • Phone: 704-333-2446
  • Fax: 704-333-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA ENOCH
Title or Position: OWNER
Credential: LCMHC
Phone: 704-807-2181