Healthcare Provider Details

I. General information

NPI: 1669222402
Provider Name (Legal Business Name): ELYSIUM COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N SPENCE AVE
GOLDSBORO NC
27534-4233
US

IV. Provider business mailing address

660 N SPENCE AVE
GOLDSBORO NC
27534-4233
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-4460
  • Fax:
Mailing address:
  • Phone: 919-330-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAELA FORSYTHE
Title or Position: CEO
Credential: LCMHC, LCAS, CSI
Phone: 919-221-7883