Healthcare Provider Details

I. General information

NPI: 1386489458
Provider Name (Legal Business Name): NEW SALEM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 COUNTRY CLUB RD
WINSTON SALEM NC
27104-2429
US

IV. Provider business mailing address

5101 COUNTRY CLUB RD
WINSTON SALEM NC
27104-2429
US

V. Phone/Fax

Practice location:
  • Phone: 336-714-5465
  • Fax:
Mailing address:
  • Phone: 336-714-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DONALD SCHMIDT
Title or Position: EXECUTIVE DIRECTOR
Credential: LCMHC
Phone: 336-714-5503