Healthcare Provider Details

I. General information

NPI: 1336533116
Provider Name (Legal Business Name): AVALON COUNSELING SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 B ARSENAL AVE
FAYETTEVILLE NC
28305
US

IV. Provider business mailing address

PO BOX 87041
FAYETTEVILLE NC
28304-7041
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-0965
  • Fax: 910-323-0310
Mailing address:
  • Phone: 910-323-0965
  • Fax: 910-323-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5091
License Number StateNC

VIII. Authorized Official

Name: MRS. DEBORAH LYNN FOLEY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPCS
Phone: 910-323-0965