Healthcare Provider Details

I. General information

NPI: 1760021166
Provider Name (Legal Business Name): UNIQUELYU COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 VILLAGE PARK DR 1047
KNIGHTDALE NC
27545-6622
US

IV. Provider business mailing address

4033 VILLAGE PARK DR 1047
KNIGHTDALE NC
27545
US

V. Phone/Fax

Practice location:
  • Phone: 816-866-0373
  • Fax:
Mailing address:
  • Phone: 816-866-0373
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LIANA K NELSON
Title or Position: PSYCHOTHERAPIST
Credential: LPC, LCMHC, SATP
Phone: 816-866-0373