=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821908823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPACE FOR BOTH COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2026
-----------------------------------------------------
Last Update Date | 09/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 ELON CT
-----------------------------------------------------
City | ELON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27244-9771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-260-3499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 ELON CT
-----------------------------------------------------
City | ELON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27244-9771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-260-3499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | KATIE MARIE CHRISCO
-----------------------------------------------------
Credential | LCMHC
-----------------------------------------------------
Telephone | 336-260-3499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------