Healthcare Provider Details

I. General information

NPI: 1518317767
Provider Name (Legal Business Name): TRINITY CHRISTIAN COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 HENNING DR
WINSTON SALEM NC
27106-4558
US

IV. Provider business mailing address

PO BOX 1083
LEWISVILLE NC
27023-1083
US

V. Phone/Fax

Practice location:
  • Phone: 336-291-7477
  • Fax: 336-217-8044
Mailing address:
  • Phone: 336-291-7477
  • Fax: 336-217-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7433
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA MOORE
Title or Position: CEO
Credential: MS, NCC, LPC, BCPCC
Phone: 336-345-9246