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General NPI Number Information
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NPI Number | 1518770932
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Entity Type | Organization
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Legal Business Name | MACNIFICENT COUNSELING AND THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 3011 TOWN CENTER DR STE 130
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-0049
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Country | US
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Telephone | 919-937-5248
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Fax |
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Provider Business Mailing Address
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Address Line | 7893 ALLSCOTT WAY
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City | RALEIGH
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State | NC
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Zip | 27612-1957
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | BRITTNEY MCCALLUM
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Credential |
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Telephone | 919-937-5248
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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 |
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License Number State |
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