Healthcare Provider Details

I. General information

NPI: 1427529155
Provider Name (Legal Business Name): WELLNESS WITHIN PROFESSIONAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N CROATAN HWY STE F
KILL DEVIL HILLS NC
27948-9356
US

IV. Provider business mailing address

111 SHORE DR
SHILOH NC
27974-6241
US

V. Phone/Fax

Practice location:
  • Phone: 252-339-4915
  • Fax:
Mailing address:
  • Phone: 252-339-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE LYNN DUNAVANT
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC, NCC
Phone: 252-339-4915