Healthcare Provider Details

I. General information

NPI: 1891380721
Provider Name (Legal Business Name): I ROCK THERAPY COUNSELING & CONSULTING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N MCPHERSON CHURCH RD
FAYETTEVILLE NC
28303-4495
US

IV. Provider business mailing address

218 N MCPHERSON CHURCH RD
FAYETTEVILLE NC
28303-4495
US

V. Phone/Fax

Practice location:
  • Phone: 910-241-0665
  • Fax:
Mailing address:
  • Phone: 910-241-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHNIKA DAVIS
Title or Position: THERAPIST
Credential: LCSW
Phone: 910-241-0665