Healthcare Provider Details

I. General information

NPI: 1588907414
Provider Name (Legal Business Name): JOYCE PHYLLIS NYIRENDA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE PHYLLIS CHILONGO

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 A S. EAST STREET ASPIRE SUPPORTIVE & COUNSELING SERVICES, LLC
RALEIGH NC
27601-7220
US

IV. Provider business mailing address

11721 COPPERGATE DR UNIT 109
RALEIGH NC
27614-9598
US

V. Phone/Fax

Practice location:
  • Phone: 919-835-1888
  • Fax: 919-835-1889
Mailing address:
  • Phone: 919-830-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7670
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number7670
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7670
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: