=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609890268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATES IN CHRISTIAN COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 11/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8025 N POINT BLVD SUITE 231
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27106-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-896-0065
-----------------------------------------------------
Fax | 336-896-0710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8025 N POINT BLVD SUITE 231
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27106-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-896-0065
-----------------------------------------------------
Fax | 336-896-0710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MGR, OPERATIONS & DEVELOPMENT
-----------------------------------------------------
Name | MR. RICK E. COLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-896-0065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3057
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------