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General NPI Number Information
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NPI Number | 1073054383
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Entity Type | Organization
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Legal Business Name | GREAT MINDS THINK ALIKE, PLLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 690 N REILLY RD SUITE 9
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5724
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Country | US
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Telephone | 910-853-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48219
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City | CUMBERLAND
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State | NC
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Zip | 28331-8219
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Country | US
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Telephone | 910-853-2580
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. ENAUSA DAVIS
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Credential | LPC, NCC, BCPCC, BCC
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Telephone | 404-593-5391
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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 | 7648
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License Number State | NC
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