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General NPI Number Information
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NPI Number | 1548431992
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Entity Type | Organization
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Legal Business Name | COUNSELING & CONSULTING PROFESSIONALS OF NC, PLLC
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 7318 RIDGEFIELD DR
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City | CHARLOTTE
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State | NC
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Zip | 28269-9155
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Country | US
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Telephone | 704-770-7743
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Fax |
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Provider Business Mailing Address
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Address Line | 7318 RIDGEFIELD DR
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City | CHARLOTTE
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State | NC
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Zip | 28269-9155
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Country | US
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Telephone | 704-770-7743
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | M. LESLIE OWENS
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Credential | L.C.S.W.
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Telephone | 704-770-7743
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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 | C005595
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License Number State | NC
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