=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437448610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOICES COUNSELING ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2011
-----------------------------------------------------
Last Update Date | 08/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 WAKE FOREST RD 2200 WAKE FOREST ROAD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27608-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-538-6859
-----------------------------------------------------
Fax | 919-809-9788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 90021
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27675-0021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-538-6859
-----------------------------------------------------
Fax | 919-809-9788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCPAL/OWNER
-----------------------------------------------------
Name | MR. CLAYTON ALEXANDER LUMSDEN
-----------------------------------------------------
Credential | MSW, LCSW, LCAS, CCS
-----------------------------------------------------
Telephone | 919-538-6859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C005326
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------