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General NPI Number Information
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NPI Number | 1053789396
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Entity Type | Organization
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Legal Business Name | TRUE IMPACT COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 4208 SIX FORKS RD STE 1000
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City | RALEIGH
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State | NC
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Zip | 27609-5738
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Country | US
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Telephone | 919-578-8110
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 SIX FORKS RD STE 1000
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City | RALEIGH
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State | NC
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Zip | 27609-5738
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Country | US
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Telephone | 919-915-4800
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Fax |
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Authorized Official
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Title or Position | LCMHC
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Name | MR. TRAVIS EDWARD WILLIAMS
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Credential | LCMHC
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Telephone | 919-915-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8845
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License Number State | NC
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