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General NPI Number Information
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NPI Number | 1306392493
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Entity Type | Organization
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Legal Business Name | JM COUNSELING & SUPPORT SERVICES
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 1811 SARDIS RD N
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City | CHARLOTTE
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State | NC
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Zip | 28270-1426
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Country | US
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Telephone | 917-204-4218
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 SARDIS RD. NORTH
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City | CHARLOTTE
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State | NC
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Zip | 28270
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Country | US
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Telephone | 917-204-4218
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH MINAYA
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Credential | LCSW
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Telephone | 917-204-4218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C009666
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License Number State | NC
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