Healthcare Provider Details

I. General information

NPI: 1831658285
Provider Name (Legal Business Name): SALEM COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S STRATFORD RD STE A
WINSTON SALEM NC
27103-1872
US

IV. Provider business mailing address

1959 N PEACE HAVEN RD STE 123
WINSTON SALEM NC
27106-4850
US

V. Phone/Fax

Practice location:
  • Phone: 336-934-4670
  • Fax:
Mailing address:
  • Phone: 336-934-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS CHASE SALMONS
Title or Position: MANAGING MEMBER, OWNER
Credential: LPC
Phone: 336-416-1912