Healthcare Provider Details

I. General information

NPI: 1962422881
Provider Name (Legal Business Name): THE CENTER FOR COUNSELING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W KINGS HWY SUITE 1
EDEN NC
27288-5013
US

IV. Provider business mailing address

439 W KINGS HWY SUITE 1
EDEN NC
27288-5013
US

V. Phone/Fax

Practice location:
  • Phone: 336-623-1800
  • Fax: 336-627-1785
Mailing address:
  • Phone: 336-623-1800
  • Fax: 336-627-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3239
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number761
License Number StateNC

VIII. Authorized Official

Name: MRS. GLORIA P. WRAY
Title or Position: PRESIDENT
Credential: LPC
Phone: 336-623-1800