Healthcare Provider Details

I. General information

NPI: 1174754675
Provider Name (Legal Business Name): PROGRESSIVE HELATHCARE & COUNSELING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4086 BARRETT DR
RALEIGH NC
27609-6604
US

IV. Provider business mailing address

476 S PARLIAMENT WAY
CLAYTON NC
27520-5055
US

V. Phone/Fax

Practice location:
  • Phone: 919-694-6402
  • Fax: 800-875-5876
Mailing address:
  • Phone: 919-520-1783
  • Fax: 800-875-5876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8109498
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3862
License Number StateNC

VIII. Authorized Official

Name: LLEWELLYN HICKS
Title or Position: DIRECTOR
Credential: MSW
Phone: 919-694-6402