Healthcare Provider Details

I. General information

NPI: 1265285100
Provider Name (Legal Business Name): WOVEN MEMORIES COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 05/08/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANFORD DR # 284
MORGANTON NC
28655-2574
US

IV. Provider business mailing address

320 SANFORD DR # 284
MORGANTON NC
28655-2574
US

V. Phone/Fax

Practice location:
  • Phone: 828-214-7851
  • Fax:
Mailing address:
  • Phone: 828-214-7851
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LENNI MARIE TRAVIS
Title or Position: OWNER/COUNSELOR
Credential: LCMHC-A, LCAS-A
Phone: 828-432-6988