=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790432607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THROUGH THE CRACKS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2022
-----------------------------------------------------
Last Update Date | 03/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 6TH ST STE D
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-407-3859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 PADS RD
-----------------------------------------------------
City | WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28697-7618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NANCY BILLINGS WOOD
-----------------------------------------------------
Credential | LCMHCA
-----------------------------------------------------
Telephone | 336-407-3859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------