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General NPI Number Information
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NPI Number | 1124817382
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Entity Type | Organization
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Legal Business Name | CARDINAL COUNSELING CONNECTION
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 717 GREEN VALLEY RD STE 206
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City | GREENSBORO
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State | NC
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Zip | 27408-2156
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Country | US
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Telephone | 336-517-7120
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Fax |
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Provider Business Mailing Address
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Address Line | 102 W CARDWELL ST
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City | MADISON
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State | NC
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Zip | 27025-1704
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Country | US
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Telephone | 219-201-3328
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MATTHEW RYAN WILSON
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Credential | LCMHC
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Telephone | 219-201-3328
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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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