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General NPI Number Information
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NPI Number | 1104487107
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Entity Type | Organization
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Legal Business Name | IV SEASONS CONSULTING
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 815 N ARENDELL AVE STE 2E
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City | ZEBULON
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State | NC
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Zip | 27597-2305
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Country | US
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Telephone | 919-375-4866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14449
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City | RALEIGH
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State | NC
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Zip | 27620-4449
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Country | US
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Telephone | 919-669-0004
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Fax | 919-375-4866
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA LAVERNE KING
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Credential | LCASA
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Telephone | 919-669-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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