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General NPI Number Information
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NPI Number | 1740805019
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Entity Type | Organization
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Legal Business Name | ESSENTIAL WELLNESS COUNSELING PLLC
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 4350 MAIN ST STE 213
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City | HARRISBURG
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State | NC
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Zip | 28075-7448
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Country | US
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Telephone | 980-236-1704
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Fax | 980-206-0709
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Provider Business Mailing Address
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Address Line | 4350 MAIN ST STE 213
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City | HARRISBURG
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State | NC
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Zip | 28075-7448
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Country | US
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Telephone | 980-236-1704
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Fax | 980-206-0709
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | TYEEKIA BLUE
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Credential | LCSW, LCAS
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Telephone | 980-236-1704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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