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General NPI Number Information
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NPI Number | 1639616782
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Entity Type | Organization
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Legal Business Name | CAROLINA COUNSELING AND CONSULTING SERVICES, PLLC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 10105 HICKORYWOOD HILL AVE SUITE B
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City | HUNTSVILLE
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State | NC
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Zip | 28078
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Country | US
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Telephone | 704-266-4208
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Fax | 866-876-6809
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Provider Business Mailing Address
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Address Line | 531 BRENTWOOD ROAD # 308
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City | DENVER
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State | NC
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Zip | 28037-0269
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Country | US
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Telephone | 704-266-4208
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Fax | 866-876-6809
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | JENNIFER ELIZABETH KEEVER
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Credential |
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Telephone | 704-266-4208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11085
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License Number State | NC
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