Healthcare Provider Details

I. General information

NPI: 1952062846
Provider Name (Legal Business Name): KABRYA ELIZABETH COLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 S ELM EUGENE ST STE 2305
GREENSBORO NC
27406-2200
US

IV. Provider business mailing address

1451 S ELM EUGENE ST STE 2305
GREENSBORO NC
27406-2200
US

V. Phone/Fax

Practice location:
  • Phone: 704-349-3789
  • Fax: 336-217-8455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA17012
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA17012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: