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General NPI Number Information
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NPI Number | 1588065718
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Entity Type | Organization
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Legal Business Name | ENDEAVOR COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 400 N BROOME ST
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City | WAXHAW
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State | NC
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Zip | 28173-7032
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Country | US
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Telephone | 516-551-4942
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 CORAL BERRY LN
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City | WAXHAW
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State | NC
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Zip | 28173-8089
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Country | US
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Telephone | 516-551-4942
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CRISTEN MONTAGNINO
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Credential |
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Telephone | 516-551-4942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 529
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License Number State | NC
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