=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003305905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BTA COUNSELING & CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2018
-----------------------------------------------------
Last Update Date | 05/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1106 GUM BRANCH RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-5743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-370-1333
-----------------------------------------------------
Fax | 910-356-9163
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 BALSAM RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-8508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-333-1333
-----------------------------------------------------
Fax | 910-356-9163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | RONALD L DINGLE
-----------------------------------------------------
Credential | LPC, LCAS
-----------------------------------------------------
Telephone | 910-370-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 16109
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C008338
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 8784
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------