Healthcare Provider Details

I. General information

NPI: 1891297230
Provider Name (Legal Business Name): CPL COUNSELING & CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W EHRINGHAUS ST
ELIZABETH CITY NC
27909-4959
US

IV. Provider business mailing address

1016 W EHRINGHAUS ST
ELIZABETH CITY NC
27909-4959
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-8139
  • Fax: 252-557-3549
Mailing address:
  • Phone: 252-384-8139
  • Fax: 252-557-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20639
License Number StateNC

VIII. Authorized Official

Name: MS. STEPHANIE R PAGE
Title or Position: ADMINISTATOR
Credential:
Phone: 252-384-8139