=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427770684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENLIGHTENED COUNSELING AND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2022
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 S MAIN ST STE 7
-----------------------------------------------------
City | KANNAPOLIS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28081-4915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-269-8773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 SPENCER LN
-----------------------------------------------------
City | KANNAPOLIS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28081-0012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-224-3077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/ ORGANIZER
-----------------------------------------------------
Name | MRS. HALBREONDA MCNEILL HOLLOWAY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 704-224-3077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------