Healthcare Provider Details

I. General information

NPI: 1104174796
Provider Name (Legal Business Name): ANDIXON CONSULTING & COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S MADISON ST
WHITEVILLE NC
28472-4613
US

IV. Provider business mailing address

677 DICKSON RD
RIEGELWOOD NC
28456-8066
US

V. Phone/Fax

Practice location:
  • Phone: 910-914-6081
  • Fax: 910-914-6116
Mailing address:
  • Phone: 336-268-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TRAVIS SWINDELL ANDREWS
Title or Position: OWNER
Credential: LPC
Phone: 336-268-5519