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General NPI Number Information
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NPI Number | 1174848733
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Entity Type | Organization
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Legal Business Name | SQUARE ONE COUNSELING PLLC
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 505B OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3433
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Country | US
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Telephone | 910-483-0005
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Fax | 910-483-0045
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | STEDMAN
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State | NC
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Zip | 28391-0262
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Country | US
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Telephone | 910-483-0005
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Fax | 910-483-0045
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Authorized Official
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Title or Position | OWNER
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Name | JOANNA NUNEZ
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Credential | MSW, LCAS, LCSW
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Telephone | 910-483-0005
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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 | 1437
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006542
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License Number State | NC
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