Healthcare Provider Details

I. General information

NPI: 1134532823
Provider Name (Legal Business Name): HOLISTIC COUNSELING & CONSULTATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WT HARRIS BLVD 2ND FLOOR
CHARLOTTE NC
28213-4285
US

IV. Provider business mailing address

PO BOX 681212
CHARLOTTE NC
28216-0022
US

V. Phone/Fax

Practice location:
  • Phone: 888-502-9591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP008754
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberP008754
License Number StateNC

VIII. Authorized Official

Name: TEAL PEOPLES
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW, LCAS, CCSA
Phone: 888-502-9591