Healthcare Provider Details

I. General information

NPI: 1033890793
Provider Name (Legal Business Name): CAROLINA COUNSELORS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 W 4TH ST STE 204
WINSTON SALEM NC
27101-2564
US

IV. Provider business mailing address

936 W 4TH ST STE 204
WINSTON SALEM NC
27101-2564
US

V. Phone/Fax

Practice location:
  • Phone: 336-655-6955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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

VIII. Authorized Official

Name: TERESA PREVATTE
Title or Position: OWNER
Credential: LCMHC, LCAS
Phone: 336-655-6955