Healthcare Provider Details

I. General information

NPI: 1033008982
Provider Name (Legal Business Name): INTRINSIC COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 EAST BLVD STE 9B
CHARLOTTE NC
28203-5817
US

IV. Provider business mailing address

14345 SAN PAOLO LN BLDG 5
CHARLOTTE NC
28277-3378
US

V. Phone/Fax

Practice location:
  • Phone: 803-724-0777
  • Fax: 980-999-8411
Mailing address:
  • Phone: 803-724-0777
  • Fax: 980-999-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TODDRIC D THOMAS
Title or Position: COO
Credential: LPN, CPSS
Phone: 803-724-0777