Healthcare Provider Details

I. General information

NPI: 1962928697
Provider Name (Legal Business Name): SPRING LAKE COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN ST
SPRING LAKE NC
28390-3902
US

IV. Provider business mailing address

856 SATINWOOD CT
FAYETTEVILLE NC
28312-8110
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-9375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS8649
License Number StateNC

VIII. Authorized Official

Name: AMBER KENNEDY
Title or Position: OWNER
Credential:
Phone: 812-223-0596