Healthcare Provider Details

I. General information

NPI: 1710540984
Provider Name (Legal Business Name): DANDELION COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 WATERS EDGE DR STE 100D
RALEIGH NC
27606-2462
US

IV. Provider business mailing address

4909 WATERS EDGE DR STE 100D
RALEIGH NC
27606-2462
US

V. Phone/Fax

Practice location:
  • Phone: 984-989-3816
  • Fax: 984-538-0448
Mailing address:
  • Phone: 984-989-3816
  • Fax: 984-538-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER M GOODSON
Title or Position: OWNER, OUTPATIENT THERAPIST
Credential: LPC, NCC, LCAS
Phone: 607-759-0146