Healthcare Provider Details

I. General information

NPI: 1710508205
Provider Name (Legal Business Name): BANNER CONSULTING AND COUNSELING OF NORTH CAROLINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 RAEFORD RD STE B
FAYETTEVILLE NC
28305-5092
US

IV. Provider business mailing address

2525 RAEFORD RD STE B
FAYETTEVILLE NC
28305-5092
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-8901
  • Fax: 910-891-8902
Mailing address:
  • Phone: 910-491-8901
  • Fax: 910-891-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROL MICHELLE DUKE
Title or Position: OWNER
Credential: LCSW
Phone: 912-335-9490