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General NPI Number Information
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NPI Number | 1194348557
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Entity Type | Organization
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Legal Business Name | IMMERSE & EMERGE COUNSELING
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 10617 KETTERING DR STE 113
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City | CHARLOTTE
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State | NC
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Zip | 28226-4900
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Country | US
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Telephone | 866-977-9067
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Fax | 866-977-9159
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Provider Business Mailing Address
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Address Line | 2413 HAWTHORNE RD
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City | LYNCHBURG
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State | VA
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Zip | 24503-2905
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Country | US
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Telephone | 434-660-5848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA PALACIOS
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Credential | LPC
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Telephone | 434-660-5848
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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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