Healthcare Provider Details

I. General information

NPI: 1295641942
Provider Name (Legal Business Name): REPORE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HOLDEN BEACH RD SW # 106
SHALLOTTE NC
28470-1787
US

IV. Provider business mailing address

117 HOLDEN BEACH RD SW # 106
SHALLOTTE NC
28470-1787
US

V. Phone/Fax

Practice location:
  • Phone: 919-588-4035
  • Fax:
Mailing address:
  • Phone: 919-588-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO DELANE ROPER
Title or Position: OWNER
Credential: LCMHCS, LCAS, CCS
Phone: 919-588-4035