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General NPI Number Information
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NPI Number | 1104174796
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Entity Type | Organization
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Legal Business Name | ANDIXON CONSULTING & COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 809 S MADISON ST
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City | WHITEVILLE
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State | NC
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Zip | 28472-4613
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Country | US
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Telephone | 910-914-6081
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Fax | 910-914-6116
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Provider Business Mailing Address
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Address Line | 677 DICKSON RD
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City | RIEGELWOOD
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State | NC
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Zip | 28456-8066
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Country | US
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Telephone | 336-268-5519
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TRAVIS SWINDELL ANDREWS
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Credential | LPC
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Telephone | 336-268-5519
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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