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General NPI Number Information
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NPI Number | 1851532907
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Entity Type | Organization
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Legal Business Name | INTENTIONAL INTERVENTION, INC.
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 1329 SALEM RD
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City | MORGANTON
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State | NC
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Zip | 28655-4835
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Country | US
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Telephone | 828-437-5901
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Fax | 828-437-8419
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Provider Business Mailing Address
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Address Line | PO BOX 655
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City | DREXEL
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State | NC
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Zip | 28619-0655
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Country | US
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Telephone | 828-413-5421
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANGELA J. DIDWAY
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Credential |
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Telephone | 828-413-5421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6458
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License Number State | NC
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