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General NPI Number Information
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NPI Number | 1306683909
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Entity Type | Organization
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Legal Business Name | RADICAL LOVE & LIBERATION COUNSELING PLLC
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 4909 WATERS EDGE DR STE 101D
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City | RALEIGH
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State | NC
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Zip | 27606-2462
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Country | US
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Telephone | 984-334-2867
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Fax | 919-551-7541
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Provider Business Mailing Address
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Address Line | 7283 VETERANS PKWY STE 102-182
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City | RALEIGH
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State | NC
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Zip | 27603-7529
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Country | US
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Telephone | 984-334-2867
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Fax | 919-551-7541
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Authorized Official
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Title or Position | CO-OWNER, LICENSED COUNSELOR
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Name | MR. KEVIN B. EASON
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Credential | MA, LCMHCA (NC), NCC
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Telephone | 984-334-2867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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