=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831438175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L & B COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2013
-----------------------------------------------------
Last Update Date | 02/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 HARDING PL SUITE 250
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-995-7312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 49294
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-0076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TRENT MORROW
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 704-995-7312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C005054
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------