Healthcare Provider Details

I. General information

NPI: 1982387866
Provider Name (Legal Business Name): THE HEALING CENTER COUNSELING & CONSULTING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 32ND AVE S STE 105
FARGO ND
58103-5910
US

IV. Provider business mailing address

1602 35TH ST S APT 15
FARGO ND
58103-8420
US

V. Phone/Fax

Practice location:
  • Phone: 701-261-2455
  • Fax:
Mailing address:
  • Phone: 701-261-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHENIKA BORDEAUX-COLLINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-261-2455