Healthcare Provider Details

I. General information

NPI: 1821908823
Provider Name (Legal Business Name): SPACE FOR BOTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2100 ELON CT
ELON NC
27244-9771
US

IV. Provider business mailing address

2100 ELON CT
ELON NC
27244-9771
US

V. Phone/Fax

Practice location:
  • Phone: 336-260-3499
  • Fax:
Mailing address:
  • Phone: 336-260-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATIE MARIE CHRISCO
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: LCMHC
Phone: 336-260-3499