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General NPI Number Information
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NPI Number | 1083283808
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Entity Type | Organization
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Legal Business Name | CENTRAL CAROLINA COUNSELING ASSOCIATES, PLLC
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 2311 W CONE BLVD STE 234
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City | GREENSBORO
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State | NC
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Zip | 27408-4062
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Country | US
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Telephone | 336-396-7545
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Fax |
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Provider Business Mailing Address
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Address Line | 4 FRIENDSMEADOW DR APT A
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City | GREENSBORO
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State | NC
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Zip | 27410-2778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/WONER
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Name | MARCELLA PETRINI GRAZIANO
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Credential | LHMHC
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Telephone | 336-420-5909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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