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General NPI Number Information
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NPI Number | 1821496860
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Entity Type | Organization
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Legal Business Name | KAKOURAS FAMILY COUNSELING, PLLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 400 N BROOME ST SUITE 303
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City | WAXHAW
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State | NC
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Zip | 28173
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Country | US
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Telephone | 704-560-4918
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N BROOME ST SUITE 303
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City | WAXHAW
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State | NC
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Zip | 28173
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Country | US
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Telephone | 704-560-4918
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. MELISSA L MAGEE-KAKOURAS
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Credential | MSW
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Telephone | 704-560-4918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1395
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006572
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006451
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License Number State | NC
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