Healthcare Provider Details

I. General information

NPI: 1447985577
Provider Name (Legal Business Name): TRIPLE C COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 WILLOW BREEZE CT
ZEBULON NC
27597-9703
US

IV. Provider business mailing address

508 WILLOW BREEZE CT
ZEBULON NC
27597-9703
US

V. Phone/Fax

Practice location:
  • Phone: 919-307-9124
  • Fax:
Mailing address:
  • Phone: 919-307-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORIA MIRANDA
Title or Position: OWNER/CLINICIAN
Credential: LCMHC
Phone: 919-307-9124