Healthcare Provider Details

I. General information

NPI: 1851715486
Provider Name (Legal Business Name): SPRING LAKE COUNSELING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PERSON CT
SPRING LAKE NC
28390-1685
US

IV. Provider business mailing address

100 PERSON CT
SPRING LAKE NC
28390-1685
US

V. Phone/Fax

Practice location:
  • Phone: 207-521-1171
  • Fax: 877-454-5541
Mailing address:
  • Phone: 207-521-1171
  • Fax: 877-454-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007755
License Number StateNC

VIII. Authorized Official

Name: ANNE MALENA
Title or Position: OWNER
Credential: LCSW
Phone: 207-521-1171