Healthcare Provider Details

I. General information

NPI: 1578845582
Provider Name (Legal Business Name): KV CONSULTANTS AND ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E 6TH ST
LUMBERTON NC
28358-5509
US

IV. Provider business mailing address

PO BOX 943
FAYETTEVILLE NC
28302-0943
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-7114
  • Fax: 910-223-0098
Mailing address:
  • Phone: 910-223-7114
  • Fax: 910-223-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH L VASQUEZ
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 910-223-7114