Healthcare Provider Details

I. General information

NPI: 1194362566
Provider Name (Legal Business Name): NXTSTEP COUNSELING AND SUPPORT SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8396 SIX FORKS RD STE 102
RALEIGH NC
27615-3058
US

IV. Provider business mailing address

8396 SIX FORKS RD STE 102
RALEIGH NC
27615-3058
US

V. Phone/Fax

Practice location:
  • Phone: 919-576-0390
  • Fax:
Mailing address:
  • Phone: 919-576-0390
  • 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
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEONDRA CRUDUP
Title or Position: OWNER
Credential: LCSW
Phone: 919-748-7048