Healthcare Provider Details

I. General information

NPI: 1467067785
Provider Name (Legal Business Name): KNOX COUNSELING AND CONSULTING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 NEW BRIDGE ST-SUITE 500
JACKSONVILLE NC
28540
US

IV. Provider business mailing address

108 EDGEFIELD DR
JACKSONVILLE NC
28546-8650
US

V. Phone/Fax

Practice location:
  • Phone: 813-928-0952
  • Fax:
Mailing address:
  • Phone: 813-928-0952
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ABBEY H KNOX
Title or Position: OWNER
Credential: MA, LMHC, LCMHC, LPC
Phone: 813-928-0952