Healthcare Provider Details

I. General information

NPI: 1982902227
Provider Name (Legal Business Name): CAPE FEAR CASE MANAGEMENT & COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4536 TECHNOLOGY DR SUITE 2
WILMINGTON NC
28405-2172
US

IV. Provider business mailing address

4536 TECHNOLOGY DR SUITE 2
WILMINGTON NC
28405-2172
US

V. Phone/Fax

Practice location:
  • Phone: 910-399-6184
  • Fax: 910-399-6186
Mailing address:
  • Phone: 910-399-6184
  • Fax: 910-399-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER KATHRYN PARRELLA
Title or Position: OWNER/DIRECTOR
Credential: MS, LPC
Phone: 910-399-6184