Healthcare Provider Details

I. General information

NPI: 1790559664
Provider Name (Legal Business Name): BE STILL COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/27/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12016 SADDLE BACK TRL
STANFIELD NC
28163-0047
US

IV. Provider business mailing address

12016 SADDLE BACK TRL
STANFIELD NC
28163-0047
US

V. Phone/Fax

Practice location:
  • Phone: 704-681-0962
  • Fax:
Mailing address:
  • Phone: 704-681-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHTON TAYLOR
Title or Position: THERAPIST
Credential: MS, LCMHCA
Phone: 704-681-0962