Healthcare Provider Details

I. General information

NPI: 1760359079
Provider Name (Legal Business Name): MARIGOLD MOON COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4688 MOUNTAIN CREEK AVE STE 104
DENVER NC
28037-6803
US

IV. Provider business mailing address

PO BOX 33
MAIDEN NC
28650-0033
US

V. Phone/Fax

Practice location:
  • Phone: 828-468-7250
  • Fax:
Mailing address:
  • Phone: 828-468-7250
  • 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: JENNIFER L DANDEKAR ROWAN
Title or Position: ORGANIZER
Credential: LCSW
Phone: 828-468-7250