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General NPI Number Information
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NPI Number | 1295216562
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Entity Type | Organization
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Legal Business Name | SOUTHEAST COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 6405 CAMDEN RD STE 109
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-7584
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Country | US
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Telephone | 910-835-6653
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Fax | 910-425-0013
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Provider Business Mailing Address
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Address Line | 6405 CAMDEN RD STE 109
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-7584
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Country | US
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Telephone | 910-835-6653
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Fax | 910-425-0013
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Authorized Official
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Title or Position | PASTORAL PSYCHOTHERAPIST
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Name | DR. WILEY EDGAR HUGHES
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Credential | LCMHC, PSYD
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Telephone | 910-835-6653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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